Provider Demographics
NPI:1710160932
Name:BANKS, BERNICE O (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:O
Last Name:BANKS
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 1:1525 E 53RD ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:773-493-9477
Mailing Address - Fax:773-734-4924
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 411
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-493-9477
Practice Address - Fax:773-734-4924
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01638407OtherBLUE CROSS BLUE SHIELD