MEDICARE: LISA RIFE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1316302219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA RIFE, LCSW

Provider Business Mailing Address
First Line	:	2451 N LINCOLN AVE
Second Line	:	209
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE
Second Line	:	209
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	312-890-2243
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	LISA RIFE
Credential	:
Telephone Number	:	773-484-0630

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	11/14/2016

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