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NPI Code Detail

MEDICARE: MS. GINA ALEXANDRA SOURELIS-SMITH LCSW

MEDICARE: MS. GINA ALEXANDRA SOURELIS-SMITH 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
11041C0700XClinical Social Worker149.012923IL

General Provider Information

NPI Number : 1881914125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GINA ALEXANDRA SOURELIS-SMITH LCSW
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 1100
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2954
Country : US
Telephone Number : 312-695-5060
Fax Number : 312-695-5010
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 1100
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2954
Country : US
Telephone Number : 312-695-5060
Fax Number : 312-695-5010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2010
Last Update Date : 06/25/2025

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