MEDICARE: MR. GREGG STEVEN KITZIS L.C.S.W.

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	149.000541	IL

General Provider Information

NPI Number	:	1558373191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGG STEVEN KITZIS L.C.S.W.

Provider Business Mailing Address
First Line	:	1027 HAYES AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1413
Country	:	US
Telephone Number	:	708-386-2578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 HAYES AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1413
Country	:	US
Telephone Number	:	708-386-2578
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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