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NPI Code Detail

MEDICARE: DEBORAH BIRCH-GAYTAN M.A.

MEDICARE:   DEBORAH  BIRCH-GAYTAN  M.A.
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
11041C0700XClinical Social Worker149.013893IL

General Provider Information

NPI Number : 1679803068
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH BIRCH-GAYTAN M.A.
Provider Business Mailing Address
First Line : 4255 N WHIPPLE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60618-2515
Country : US
Telephone Number : 312-636-5003
Fax Number :
Provider Business Practice Location Address
First Line : 2528 N LINCOLN AVE
Second Line : SUITE 116
City : CHICAGO
State : IL
Zip : 60614-2333
Country : US
Telephone Number : 312-636-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2010
Last Update Date : 01/06/2010

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Directions to “ DEBORAH BIRCH-GAYTAN M.A.” Practice Location

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