Provider Demographics
NPI:1164026985
Name:PINKUS, SHIRA DEVORAH
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:DEVORAH
Last Name:PINKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:DEVORAH
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3557 W PETERSON AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3218
Mailing Address - Country:US
Mailing Address - Phone:773-478-6000
Mailing Address - Fax:
Practice Address - Street 1:3557 W PETERSON AVE STE 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3218
Practice Address - Country:US
Practice Address - Phone:773-478-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490196811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical