MEDICARE: MS. MARY M CREAMER 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	149.013054	IL

General Provider Information

NPI Number	:	1265044812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY M CREAMER LCSW

Provider Business Mailing Address
First Line	:	5201 S CALUMET AVE APT 3R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-3542
Country	:	US
Telephone Number	:	312-933-5741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 S COTTAGE GROVE AVE RM 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3514
Country	:	US
Telephone Number	:	312-933-5741
Fax Number	:

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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