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NPI Code Detail

MEDICARE: CENTER FOR RECOVERY & GROWTH, LLC

MEDICARE: CENTER FOR RECOVERY & GROWTH, LLC
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 Worker149.015422IL

General Provider Information

NPI Number : 1134521453
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR RECOVERY & GROWTH, LLC
Provider Business Mailing Address
First Line : 1628 W GREGORY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1108
Country : US
Telephone Number : 312-848-5626
Fax Number :
Provider Business Practice Location Address
First Line : 1770 W BERTEAU AVE STE 302A
Second Line :
City : CHICAGO
State : IL
Zip : 60613-1750
Country : US
Telephone Number : 773-850-0526
Fax Number :
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : BARBARA HERMAN BAYNE
Credential : LCSW
Telephone Number : 312-848-5626
Provider Enumeration Date : 09/17/2014
Last Update Date : 09/16/2020

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Directions to “CENTER FOR RECOVERY & GROWTH, LLC ” Practice Location

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