Organization
CHARLES F SMALL LCSW LLC
Active
Other names
Charles F Small LCSW
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES F SMALL LCSW (LICENSED CLINICAL SOCIAL WORKER)
(773) 307-1045
Entity
Organization
Contact information
Practice address
1465 W GRAND AVE APT 3, CHICAGO, IL 60642-8532
(773) 307-1045
Mailing address
1465 W GRAND AVE APT 3, CHICAGO, IL 60642-8532
(773) 307-1045
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149.015676
PROFESSIONAL LICENSE
IL
Enumeration date
10/25/2018
Last updated
10/25/2018
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