MEDICARE: MR. CHARLES A LERNER LCPC

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	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1386701365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES A LERNER LCPC

Provider Business Mailing Address
First Line	:	120 S MARION ST
Second Line	:	OAK PARK FAMILY SERVICE
City	:	OAK PARK
State	:	IL
Zip	:	60302-2809
Country	:	US
Telephone Number	:	708-383-7500
Fax Number	:	708-383-7780

Provider Business Practice Location Address
First Line	:	120 S MARION ST
Second Line	:	OAK PARK FAMILY SERVICE
City	:	OAK PARK
State	:	IL
Zip	:	60302-2809
Country	:	US
Telephone Number	:	708-383-7500
Fax Number	:	708-383-7780

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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