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NPI Code Detail

MEDICARE: MS. AMY GRACE FERRARA LCSW, CADC

MEDICARE: MS. AMY GRACE FERRARA 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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1902084098
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY GRACE FERRARA LCSW, CADC
Provider Business Mailing Address
First Line : 30 W CHICAGO AVE FL 4
Second Line : UNION HOUSE, NMH
City : CHICAGO
State : IL
Zip : 60610-4333
Country : US
Telephone Number : 312-282-6077
Fax Number :
Provider Business Practice Location Address
First Line : 30 W CHICAGO AVE FL 4
Second Line : UNION HOUSE, NMH
City : CHICAGO
State : IL
Zip : 60610-4333
Country : US
Telephone Number : 312-282-6077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2008
Last Update Date : 01/31/2008

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