MEDICARE: LISA L COUSER 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	149012966	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	202591	OTHER	IL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1617631	OTHER	IL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043482144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA L COUSER LCSW

Provider Business Mailing Address
First Line	:	6123 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2323
Country	:	US
Telephone Number	:	773-450-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	6123 N WOLCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2323
Country	:	US
Telephone Number	:	773-450-6363
Fax Number	:

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	01/16/2020

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Directions to “ LISA L COUSER LCSW” Practice Location

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