Provider Demographics
NPI:1548254675
Name:BELZER, KIRSTEN DANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:DANA
Last Name:BELZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 53RD ST STE 516-7
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4572
Mailing Address - Country:US
Mailing Address - Phone:773-752-5051
Mailing Address - Fax:773-752-7624
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 516-7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-643-1940
Practice Address - Fax:773-752-7624
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490059021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL560531000OtherMAGELLAN
IL1627157OtherBLUE CROSS & BLUE SHEILD
IL204166Medicare ID - Type Unspecified