Organization
CENTER FOR GRIEF RECOVERY AND SIBLING LOSS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MICHAEL FIREMAN LCSW (EXECUTIVE DIRECTOR)
(773) 274-4600
Entity
Organization
Contact information
Practice address
1263 W LOYOLA AVE, CHICAGO, IL 60626-5101
(773) 274-4600
Mailing address
1263 W LOYOLA AVE, CHICAGO, IL 60626-5101
(773) 274-4600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-006624
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001619932
GROUP NUMBER FOR BC/BS-PP
IL
Enumeration date
09/22/2006
Last updated
10/06/2009
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