MEDICARE: MS. PATRICIA A SUGRUE NCTMB

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	174400000X	Specialist	227.000757	IL
2	101YP2500X	Professional Counselor	180.014900	IL

General Provider Information

NPI Number	:	1841498490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A SUGRUE NCTMB

Provider Business Mailing Address
First Line	:	1531 W FARGO AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-7079
Country	:	US
Telephone Number	:	773-989-7562
Fax Number	:

Provider Business Practice Location Address
First Line	:	3234 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2594
Country	:	US
Telephone Number	:	773-466-9882
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	12/05/2022

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