Individual ProviderAgatha MoellerSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1230 N State Pkwy, #27c, Chicago, IL 60610-2260(312) 932-9163PECOS EnrollmentBased on the most recent information from CMS, provider Agatha Moeller does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1356645808Provider TypeIndividualFull NameMoeller, AgathaTitleMs.CredentialMSW, LCSWGenderFemaleSole ProprietorYesEnumeration Date12/27/2010Last Updated12/27/2010Contact InformationPractice LocationPractice Address1230 N State Pkwy, #27c, Chicago, IL 60610-2260Phone(312) 932-9163FaxUnlisted FaxMailing LocationMailing Address1967 N Dayton St, Chicago, IL 60614-5030Phone(312) 932-9163FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149.006303Illinois