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NPI Code Detail

MEDICARE: MRS. DOREEN K FRYMIRE-BONALDI LCSW

MEDICARE: MRS. DOREEN K FRYMIRE-BONALDI 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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1104024512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DOREEN K FRYMIRE-BONALDI LCSW
Provider Business Mailing Address
First Line : 3225 N. SHEFFIELD AVENUE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2210
Country : US
Telephone Number : 773-549-5886
Fax Number : 773-549-5892
Provider Business Practice Location Address
First Line : 3225 N. SHEFFIELD AVENUE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2210
Country : US
Telephone Number : 773-549-5886
Fax Number : 773-549-5892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2007
Last Update Date : 07/08/2007

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