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NPI Code Detail

MEDICARE: RICHARD F SHEPHERD LCSW

MEDICARE: RICHARD F SHEPHERD 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 Worker149.007520IL

General Provider Information

NPI Number : 1215251277
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD F SHEPHERD LCSW
Provider Business Mailing Address
First Line : 600 W FULTON ST
Second Line : SUITE 200
City : CHICAGO
State : IL
Zip : 60661-1259
Country : US
Telephone Number : 773-434-4135
Fax Number : 773-434-4135
Provider Business Practice Location Address
First Line : 600 W FULTON ST
Second Line : SUITE 200
City : CHICAGO
State : IL
Zip : 60661-1259
Country : US
Telephone Number : 773-434-4135
Fax Number : 773-434-4135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2010
Last Update Date : 03/19/2010

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