MEDICARE: THE FINESTRA CENTER LLC

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	149013081	IL

General Provider Information

NPI Number	:	1023336492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FINESTRA CENTER LLC

Provider Business Mailing Address
First Line	:	4569 NORTH RAVENSWOOD AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640
Country	:	US
Telephone Number	:	773-435-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	4569 NORTH RAVENSWOOD AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640
Country	:	US
Telephone Number	:	773-435-6740
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	MS. JUSTINE MARIE MCBRIDE
Credential	:	LCSW
Telephone Number	:	773-396-4578

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	06/05/2013

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