MEDICARE: VIRGINIA SHROVE 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	149002933	IL

General Provider Information

NPI Number	:	1821221466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA SHROVE LCSW

Provider Business Mailing Address
First Line	:	17746 OAK PARK AVE
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-3936
Country	:	US
Telephone Number	:	708-444-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	17746 OAK PARK AVE
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-3936
Country	:	US
Telephone Number	:	708-444-1012
Fax Number	:

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

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	09/19/2016

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