MEDICARE: HEATHER MORIN, LCSW LLC

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

General Provider Information

NPI Number	:	1437922002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER MORIN, LCSW LLC

Provider Business Mailing Address
First Line	:	3728 W SHAKESPEARE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3429
Country	:	US
Telephone Number	:	773-816-3676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3728 W SHAKESPEARE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3429
Country	:	US
Telephone Number	:	773-816-3676
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. HEATHER MORIN
Credential	:	LCSW
Telephone Number	:	773-816-3676

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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