Provider Demographics
NPI:1790839611
Name:KIRSITS, ANITA K (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:K
Last Name:KIRSITS
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 1:3122 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4936
Mailing Address - Country:US
Mailing Address - Phone:773-929-8586
Mailing Address - Fax:773-472-8903
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-472-5424
Practice Address - Fax:773-472-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
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
IL597549Medicare ID - Type Unspecified
ILR16843Medicare UPIN