MEDICARE: PHOEBE SELENE CAPLIN MSW

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	:	1215621479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOEBE SELENE CAPLIN MSW

Provider Business Mailing Address
First Line	:	1001 S STATE ST UNIT 607
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2226
Country	:	US
Telephone Number	:	434-282-4239
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 W LAKE ST STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1413
Country	:	US
Telephone Number	:	312-525-8887
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	06/08/2023

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Directions to “ PHOEBE SELENE CAPLIN MSW” Practice Location

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