MEDICARE: MS. KATHRYN BARON 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	149.018443	IL

General Provider Information

NPI Number	:	1356080345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN BARON LCSW

Provider Business Mailing Address
First Line	:	7652 MADISON ST UNIT 211
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-3074
Country	:	US
Telephone Number	:	630-247-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 E 56TH ST APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-6885
Country	:	US
Telephone Number	:	708-320-1828
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	06/02/2022

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