MEDICARE: ANGELA ATWATER 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	149010512	IL

General Provider Information

NPI Number	:	1508954785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ATWATER LCSW

Provider Business Mailing Address
First Line	:	2312 W NORTH AVE
Second Line	:	#4E
City	:	CHICAGO
State	:	IL
Zip	:	60647-6264
Country	:	US
Telephone Number	:	773-456-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N CLARK ST
Second Line	:	SUITE 413
City	:	CHICAGO
State	:	IL
Zip	:	60610-2702
Country	:	US
Telephone Number	:	773-456-9080
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	10/18/2009

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Directions to “ ANGELA ATWATER LCSW” Practice Location

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