MEDICARE: VICTORIA M. HOMINICK 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
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1184775207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA M. HOMINICK LCSW

Provider Business Mailing Address
First Line	:	7124 WINDSOR LAKE PKWY
Second Line	:	SUITE 17
City	:	LOVES PARK
State	:	IL
Zip	:	61111-3800
Country	:	US
Telephone Number	:	815-282-1807
Fax Number	:	815-282-1003

Provider Business Practice Location Address
First Line	:	7124 WINDSOR LAKE PKWY
Second Line	:	SUITE 17
City	:	LOVES PARK
State	:	IL
Zip	:	61111-3800
Country	:	US
Telephone Number	:	815-282-1807
Fax Number	:	815-282-1003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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