Provider Demographics
NPI:1023356821
Name:KANE, ALICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KANE
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 1:5710 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4302
Mailing Address - Country:US
Mailing Address - Phone:224-301-3749
Mailing Address - Fax:773-765-0356
Practice Address - Street 1:5710 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4302
Practice Address - Country:US
Practice Address - Phone:224-301-3749
Practice Address - Fax:773-765-0356
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490171811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical