MEDICARE: CHERYLANN MARIE MCGOVERN 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	149.017186	IL

General Provider Information

NPI Number	:	1235804311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYLANN MARIE MCGOVERN LCSW

Provider Business Mailing Address
First Line	:	203 LONG BEACH RD
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8073
Country	:	US
Telephone Number	:	779-200-1043
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 LONG BEACH RD
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-8073
Country	:	US
Telephone Number	:	779-200-1043
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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