MEDICARE: MR. DANIEL P BOYLE MSW, 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	149001625	IL

General Provider Information

NPI Number	:	1437385572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL P BOYLE MSW, LCSW

Provider Business Mailing Address
First Line	:	1142 CHICAGO AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 CHICAGO AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:	312-330-1450
Fax Number	:

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

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	06/03/2009

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