MEDICARE: STERN COUNSELING P.C.

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	149017295	IL

General Provider Information

NPI Number	:	1164884805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERN COUNSELING P.C.

Provider Business Mailing Address
First Line	:	2943 W FARGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1222
Country	:	US
Telephone Number	:	713-875-0890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2943 W FARGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1222
Country	:	US
Telephone Number	:	713-875-0890
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	JEREMY STERN
Credential	:	LCSW
Telephone Number	:	713-875-0890

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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