MEDICARE: UPSCALE SOCIAL SERVICES, P C

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	149001874	IL

General Provider Information

NPI Number	:	1346499183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSCALE SOCIAL SERVICES, P C

Provider Business Mailing Address
First Line	:	11214 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4126
Country	:	US
Telephone Number	:	773-233-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	11214 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4126
Country	:	US
Telephone Number	:	773-233-2017
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHARLES E PREYAR
Credential	:	L.C.S.W.
Telephone Number	:	773-233-2017

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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