MEDICARE: MS. STEPHANIE J FERRERA 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1604502	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1386699338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE J FERRERA LCSW

Provider Business Mailing Address
First Line	:	200 SOUTH MAPLE AVENUE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3026
Country	:	US
Telephone Number	:	708-383-7566
Fax Number	:	708-383-4766

Provider Business Practice Location Address
First Line	:	200 SOUTH MAPLE AVENUE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3026
Country	:	US
Telephone Number	:	708-383-7566
Fax Number	:	708-383-4766

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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