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NPI Code Detail

MEDICARE: MR. FRANK DARRYL HARRIS LCSW, CADC

MEDICARE: MR. FRANK DARRYL HARRIS LCSW, CADC
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 Worker150.010429IL
2101YA0400XAddiction (Substance Use Disorder) Counselor21137IL

General Provider Information

NPI Number : 1750713368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FRANK DARRYL HARRIS LCSW, CADC
Provider Business Mailing Address
First Line : 411 N KENNETH CT
Second Line :
City : GLENWOOD
State : IL
Zip : 60425-1205
Country : US
Telephone Number : 708-275-5886
Fax Number :
Provider Business Practice Location Address
First Line : 5517 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1515
Country : US
Telephone Number : 773-275-7962
Fax Number : 773-275-0728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2013
Last Update Date : 07/28/2015

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