Provider Demographics
NPI:1902815434
Name:SHURMAN-LAVITT, BEVERLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:SHURMAN-LAVITT
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 1:8450 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2201
Mailing Address - Country:US
Mailing Address - Phone:224-306-2248
Mailing Address - Fax:
Practice Address - Street 1:3080 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1210
Practice Address - Country:US
Practice Address - Phone:224-306-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490040641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL990340Medicare ID - Type Unspecified