Provider Demographics
NPI:1821360397
Name:BARRETT, KEVIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 303C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4580
Mailing Address - Country:US
Mailing Address - Phone:312-834-7778
Mailing Address - Fax:
Practice Address - Street 1:4619 N RAVENSWOOD
Practice Address - Street 2:SUITE 1604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7212
Practice Address - Country:US
Practice Address - Phone:312-834-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.013448104100000X
IL149.0157721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker