MEDICARE: KEVIN BARRETT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.013448	IL
2	1041C0700X	Clinical Social Worker	149.015772	IL

General Provider Information

NPI Number	:	1821360397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BARRETT LCSW

Provider Business Mailing Address
First Line	:	4619 N RAVENSWOOD AVE
Second Line	:	SUITE 303C
City	:	CHICAGO
State	:	IL
Zip	:	60640-4580
Country	:	US
Telephone Number	:	312-834-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	4619 N RAVENSWOOD
Second Line	:	SUITE 1604
City	:	CHICAGO
State	:	IL
Zip	:	60640-7212
Country	:	US
Telephone Number	:	312-834-7778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	08/04/2022

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