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NPI Code Detail

MEDICARE: MR. ANDREW JOHN LEDERMAN JR. LSW

MEDICARE: MR. ANDREW JOHN LEDERMAN JR. LSW
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
1104100000XSocial Worker150112576IL

General Provider Information

NPI Number : 1578327607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW JOHN LEDERMAN JR. LSW
Provider Business Mailing Address
First Line : 923 W OAKDALE AVE APT 3C
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5042
Country : US
Telephone Number : 508-728-2491
Fax Number :
Provider Business Practice Location Address
First Line : 2319 N ORCHARD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-0008
Country : US
Telephone Number : 773-755-7791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2024
Last Update Date : 02/08/2024

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Directions to “ MR. ANDREW JOHN LEDERMAN JR. LSW” Practice Location

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