Provider Demographics
NPI:1780921494
Name:PERRY-BELL, KENITA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:KENITA
Middle Name:J
Last Name:PERRY-BELL
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 5885
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5310
Mailing Address - Country:US
Mailing Address - Phone:630-474-5279
Mailing Address - Fax:630-785-3064
Practice Address - Street 1:2000 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-3910
Practice Address - Country:US
Practice Address - Phone:630-474-5279
Practice Address - Fax:630-785-3064
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490156791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical