MEDICARE: MORGAN WOOLLEY 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	149.015878	IL

General Provider Information

NPI Number	:	1649608126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN WOOLLEY LCSW

Provider Business Mailing Address
First Line	:	1021 N WINCHESTER AVE
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	812-878-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 N WINCHESTER AVE
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	812-878-7714
Fax Number	:

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

Provider Enumeration Date	:	10/21/2013
Last Update Date	:	10/21/2013

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