MEDICARE: BERNADETTE R GAFFNEY L.C.S.W.

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	149-007624	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633611	OTHER	IL	BLUE CROSS &BLUE SHIELD
2	566044	OTHER	IL	VALUE OPTIONS
3	300212612	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1659438216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE R GAFFNEY L.C.S.W.

Provider Business Mailing Address
First Line	:	2000 N RACINE AVE
Second Line	:	SUITE 2020
City	:	CHICAGO
State	:	IL
Zip	:	60614-4045
Country	:	US
Telephone Number	:	773-430-9644
Fax Number	:	773-770-3577

Provider Business Practice Location Address
First Line	:	2000 N RACINE AVE
Second Line	:	SUITE 2020
City	:	CHICAGO
State	:	IL
Zip	:	60614-4045
Country	:	US
Telephone Number	:	773-430-9644
Fax Number	:	773-770-3577

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/10/2013

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