MEDICARE: MRS. LANA R FRIEDMAN DAUGHERTY PHD 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	149001770	IL

General Provider Information

NPI Number	:	1053463091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANA R FRIEDMAN DAUGHERTY PHD LCSW

Provider Business Mailing Address
First Line	:	155 N MICHIGAN AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7511
Country	:	US
Telephone Number	:	773-426-8315
Fax Number	:	312-540-9737

Provider Business Practice Location Address
First Line	:	155 N MICHIGAN AVE # 500E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7511
Country	:	US
Telephone Number	:	773-426-8315
Fax Number	:	312-540-9737

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/14/2023

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