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NPI Code Detail

MEDICARE: BETH SACKETT LCSW, CADC

MEDICARE: BETH SACKETT LCSW, CADC
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 Worker149.019128IL

General Provider Information

NPI Number : 1184261760
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH SACKETT LCSW, CADC
Provider Business Mailing Address
First Line : 910 SKOKIE BLVD STE 215
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 910 SKOKIE BLVD STE 215
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4033
Country : US
Telephone Number : 847-480-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2019
Last Update Date : 12/03/2019

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