Provider Demographics
NPI:1760457287
Name:MACRAE, FREDERICK J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:J
Last Name:MACRAE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 W ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2603
Mailing Address - Country:US
Mailing Address - Phone:773-528-8477
Mailing Address - Fax:773-728-7748
Practice Address - Street 1:3257 N SHEFFIELD AVE
Practice Address - Street 2:SUITE# 119
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2270
Practice Address - Country:US
Practice Address - Phone:773-528-8477
Practice Address - Fax:773-728-7748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
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
IL0001671410OtherBLUE CROSS/ BLUE SHIELD
IL954230Medicare ID - Type Unspecified
ILR17898Medicare UPIN