MEDICARE: MR. DENNIS ANTHONY BEAUCHAMP 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		IL

General Provider Information

NPI Number	:	1912926528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS ANTHONY BEAUCHAMP LCSW

Provider Business Mailing Address
First Line	:	2834 W RASCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3214
Country	:	US
Telephone Number	:	773-989-0466
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 W. TOUHY AVE.
Second Line	:	COUNCIL FOR JEWISH ELDERLY
City	:	CHICAGO
State	:	IL
Zip	:	60645
Country	:	US
Telephone Number	:	773-508-1139
Fax Number	:	773-262-7084

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/09/2007

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