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NPI Code Detail

MEDICARE: JEFFREY N BLAINE L.C.S.W.

MEDICARE: JEFFREY N BLAINE L.C.S.W.
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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1093806614
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY N BLAINE L.C.S.W.
Provider Business Mailing Address
First Line : 803 MONROE AVE
Second Line :
City : RIVER FOREST
State : IL
Zip : 60305-1421
Country : US
Telephone Number : 312-656-5361
Fax Number : 312-558-1570
Provider Business Practice Location Address
First Line : 20 N CLARK ST
Second Line : SUITE 2650
City : CHICAGO
State : IL
Zip : 60602-4109
Country : US
Telephone Number : 312-558-1573
Fax Number : 312-558-1570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/08/2007

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Directions to “ JEFFREY N BLAINE L.C.S.W.” Practice Location

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