Healthcare Provider Details

I. General information

NPI: 1548577398
Provider Name (Legal Business Name): SHIRA BELKOV LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 W ADDISON ST APT 3N
CHICAGO IL
60618-3452
US

IV. Provider business mailing address

3012 W ADDISON ST APT 3N
CHICAGO IL
60618-3452
US

V. Phone/Fax

Practice location:
  • Phone: 773-791-5866
  • Fax:
Mailing address:
  • Phone: 773-791-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009545A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: