MEDICARE: MS. LAUREN ANNE MARCISZYN RD, LPC

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	133V00000X	Registered Dietitian	2737	MA
2	101YM0800X	Mental Health Counselor	178018798	IL

General Provider Information

NPI Number	:	1649419706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ANNE MARCISZYN RD, LPC

Provider Business Mailing Address
First Line	:	1461 W EDGEWATER AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-5683
Country	:	US
Telephone Number	:	774-644-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	5537 N CLARK ST # B-1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-0751
Country	:	US
Telephone Number	:	773-302-1609
Fax Number	:

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	01/11/2024

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