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NPI Code Detail

MEDICARE: CORRI FERDMAN LCSW LLC

MEDICARE: CORRI FERDMAN LCSW LLC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14932415OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1295809986
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORRI FERDMAN LCSW LLC
Provider Business Mailing Address
First Line : 120 W EASTMAN ST
Second Line : 301
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-5937
Country : US
Telephone Number : 847-793-0788
Fax Number : 847-793-0789
Provider Business Practice Location Address
First Line : 900 NORTH SHORE DR
Second Line : 200
City : LAKE BLUFF
State : IL
Zip : 60044-2243
Country : US
Telephone Number : 847-793-0788
Fax Number : 847-793-0789
Authorized Official
Title or Position : LCSW
Name : MISS CORRI J FERDMAN
Credential : LCSW
Telephone Number : 847-793-0788
Provider Enumeration Date : 11/17/2006
Last Update Date : 03/04/2010

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Directions to “CORRI FERDMAN LCSW LLC ” Practice Location

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