Provider Demographics
NPI:1316189020
Name:MUNRO, PETER CHARLES (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:MUNRO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 N PINE GROVE AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3392
Mailing Address - Country:US
Mailing Address - Phone:312-804-0953
Mailing Address - Fax:773-661-2688
Practice Address - Street 1:2000 N RACINE AVE # 2300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:312-804-0953
Practice Address - Fax:773-661-2688
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490135211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical