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NPI Code Detail

MEDICARE: MS. LEE DAL PRA LCSW

MEDICARE: MS. LEE DAL PRA 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 Worker149015498IL

General Provider Information

NPI Number : 1164854972
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEE DAL PRA LCSW
Provider Business Mailing Address
First Line : 2043 W BELMONT AVE STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6796
Country : US
Telephone Number : 312-667-3775
Fax Number :
Provider Business Practice Location Address
First Line : 2043 W BELMONT AVE STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6796
Country : US
Telephone Number : 312-667-3775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2013
Last Update Date : 08/02/2021

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