Provider Demographics
NPI:1184209256
Name:DENIS, ALEXANDRA (LCSW, PLLC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:DENIS
Suffix:
Gender:F
Credentials:LCSW, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N HUMPHREY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1418
Mailing Address - Country:US
Mailing Address - Phone:708-996-0296
Mailing Address - Fax:
Practice Address - Street 1:107 W VAN BUREN ST STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1054
Practice Address - Country:US
Practice Address - Phone:708-996-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0229811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical