MEDICARE: BRIAN PETER MCINTOSH LCSW, 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
1	1041C0700X	Clinical Social Worker	149.021480	IL

General Provider Information

NPI Number	:	1487062352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PETER MCINTOSH LCSW, CADC

Provider Business Mailing Address
First Line	:	3340 W POTOMAC AVE UNIT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2324
Country	:	US
Telephone Number	:	312-380-9676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 W POTOMAC AVE UNIT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2324
Country	:	US
Telephone Number	:	312-380-9676
Fax Number	:

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	12/11/2025

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