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NPI Code Detail

MEDICARE: CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C.

MEDICARE: CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C.
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
1101YP2500XProfessional Counselor178007128IL

General Provider Information

NPI Number : 1891075586
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C.
Provider Business Mailing Address
First Line : 205 W EUGENIE ST
Second Line : UNIT H
City : CHICAGO
State : IL
Zip : 60614-6067
Country : US
Telephone Number : 312-480-5528
Fax Number :
Provider Business Practice Location Address
First Line : 938 W NELSON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6704
Country : US
Telephone Number : 773-296-3169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 08/25/2011

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