Provider Demographics
NPI:1881295186
Name:DIBERT, BELVA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BELVA
Middle Name:MARIE
Last Name:DIBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:BELVA-MARIE
Other - Last Name:DIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6330 S INGLESIDE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-5784
Mailing Address - Country:US
Mailing Address - Phone:443-540-3022
Mailing Address - Fax:
Practice Address - Street 1:6330 S INGLESIDE AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-5784
Practice Address - Country:US
Practice Address - Phone:443-540-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490222581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical