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NPI Code Detail

MEDICARE: NICHOLAS J PIECHOTTE LCSW, MSW, CADC

MEDICARE: NICHOLAS J PIECHOTTE LCSW, MSW, CADC
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
11041C0700XClinical Social Worker149.0182121IL

General Provider Information

NPI Number : 1477914414
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS J PIECHOTTE LCSW, MSW, CADC
Provider Business Mailing Address
First Line : 3304 N HAMILTON AVE APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6378
Country : US
Telephone Number : 810-937-9237
Fax Number :
Provider Business Practice Location Address
First Line : 1111 N WELLS ST STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60610-7632
Country : US
Telephone Number : 312-573-8860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2016
Last Update Date : 03/18/2016

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