MEDICARE: MS. KIRSTEN DANA BELZER 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	149005902	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	560531000	OTHER	IL	MAGELLAN
2	1627157	OTHER	IL	BLUE CROSS & BLUE SHEILD

General Provider Information

NPI Number	:	1548254675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIRSTEN DANA BELZER LCSW

Provider Business Mailing Address
First Line	:	1525 E 53RD ST STE 516-7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4572
Country	:	US
Telephone Number	:	773-752-5051
Fax Number	:	773-752-7624

Provider Business Practice Location Address
First Line	:	1525 E 53RD ST
Second Line	:	SUITE 516-7
City	:	CHICAGO
State	:	IL
Zip	:	60615-4557
Country	:	US
Telephone Number	:	773-643-1940
Fax Number	:	773-752-7624

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

Provider Enumeration Date	:	09/05/2005
Last Update Date	:	09/15/2010

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