MEDICARE: VALERIE BEAVERS 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	1041C0700X	Clinical Social Worker	149010683	IL

General Provider Information

NPI Number	:	1861455297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE BEAVERS LCSW

Provider Business Mailing Address
First Line	:	4106 S CALUMET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653
Country	:	US
Telephone Number	:	773-373-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E NORTHWEST HWY STE 106B
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3457
Country	:	US
Telephone Number	:	815-326-5262
Fax Number	:	847-299-4952

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/21/2022

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Directions to “ VALERIE BEAVERS LCSW” Practice Location

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