Provider Demographics
NPI:1043368608
Name:PAULEY, GEORGE L (MSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:L
Last Name:PAULEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 N SHERIDAN RD
Mailing Address - Street 2:#4811
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1954
Mailing Address - Country:US
Mailing Address - Phone:773-784-4566
Mailing Address - Fax:
Practice Address - Street 1:464 CENTRAL AVE
Practice Address - Street 2:#30
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3040
Practice Address - Country:US
Practice Address - Phone:847-446-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-05084OtherBLUE CROSS BLUE SHIELD IL
IL932421Medicare ID - Type UnspecifiedMEDICARE