Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149017381 | IL |
NPI | 1003208604 |
---|---|
Provider Name | Timothy Feltman |
First Address | Chicago, IL 60640-4689 |
Second Address | Chicago, IL 60640-4689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2015 |
Last Update Date | 19/02/2015 |