MEDICARE: MS. PAULA ANN METZGER-NEVILLE LCPC, 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	101YP2500X	Professional Counselor	180-002217	IL
2	101YP2500X	Professional Counselor	LCPC180-002217	IL

General Provider Information

NPI Number	:	1487669842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA ANN METZGER-NEVILLE LCPC, CADC

Provider Business Mailing Address
First Line	:	3001 GREEN BAY RD.
Second Line	:	VA-BUILDING 131, ROOM 42
City	:	N. CHICAGO
State	:	IL
Zip	:	60064
Country	:	US
Telephone Number	:	224-610-3528
Fax Number	:	224-610-3778

Provider Business Practice Location Address
First Line	:	3001 GREEN BAY RD.
Second Line	:	VA-BUILDING 131, ROOM 42
City	:	N. CHICAGO
State	:	IL
Zip	:	60064
Country	:	US
Telephone Number	:	224-610-3528
Fax Number	:	224-610-3778

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/08/2012

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