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NPI Code Detail

MEDICARE: ANDREW DANIEL BAHENA LCSW, MSW, PEL: SSW

MEDICARE: ANDREW DANIEL BAHENA LCSW, MSW, PEL: SSW
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 Worker149.027119IL
21041S0200XSchool Social Worker150.110743IL

General Provider Information

NPI Number : 1952049884
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW DANIEL BAHENA LCSW, MSW, PEL: SSW
Provider Business Mailing Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Provider Business Practice Location Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2022
Last Update Date : 01/12/2026

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