MEDICARE: CATHERINE MARIE SIEGEL 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		IL

General Provider Information

NPI Number	:	1043387525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MARIE SIEGEL LCSW

Provider Business Mailing Address
First Line	:	2430 N LAKEVIEW AVE
Second Line	:	15N
City	:	CHICAGO
State	:	IL
Zip	:	60614-2877
Country	:	US
Telephone Number	:	773-528-9108
Fax Number	:	773-528-1981

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE
Second Line	:	SUITE 205
City	:	CHICAGO
State	:	IL
Zip	:	60657-3114
Country	:	US
Telephone Number	:	773-983-0022
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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