MEDICARE: MR. PHILIP L WARE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149007588	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023126273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP L WARE LCSW

Provider Business Mailing Address
First Line	:	800 E 170TH PL
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-3405
Country	:	US
Telephone Number	:	708-337-5433
Fax Number	:	708-210-1430

Provider Business Practice Location Address
First Line	:	9415 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6700
Country	:	US
Telephone Number	:	708-337-5433
Fax Number	:	708-210-1430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	04/21/2010

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