Provider Demographics
NPI:1619593282
Name:DENIS, ALISHA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
Last Name:DENIS
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:PO BOX 19351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-0266
Mailing Address - Country:US
Mailing Address - Phone:773-702-0660
Mailing Address - Fax:773-834-3756
Practice Address - Street 1:800 E. 55HTH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-0496
Practice Address - Country:US
Practice Address - Phone:773-702-0660
Practice Address - Fax:773-834-3756
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490219961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364161801001Medicaid