Provider Demographics
NPI:1598105918
Name:AZHAR, SAMEENA V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMEENA
Middle Name:V
Last Name:AZHAR
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 1:838 E 53RD ST
Mailing Address - Street 2:APT 3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4956
Mailing Address - Country:US
Mailing Address - Phone:510-896-5355
Mailing Address - Fax:
Practice Address - Street 1:838 E 53RD ST
Practice Address - Street 2:APT 3W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4956
Practice Address - Country:US
Practice Address - Phone:510-896-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607961041C0700X
IL1490169621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL462119710Medicaid
IL462119710Medicare UPIN