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NPI Code Detail

MEDICARE: DIANA KOTIS-HARBER M.S.W., LCSW

MEDICARE: DIANA KOTIS-HARBER M.S.W., 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 Worker14913527IL

General Provider Information

NPI Number : 1609136100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA KOTIS-HARBER M.S.W., LCSW
Provider Business Mailing Address
First Line : 1019 S WESTERN AVE
Second Line : UNIT 2
City : CHICAGO
State : IL
Zip : 60612-4415
Country : US
Telephone Number : 312-852-2241
Fax Number :
Provider Business Practice Location Address
First Line : 1019 S WESTERN AVE
Second Line : UNIT 2
City : CHICAGO
State : IL
Zip : 60612-4415
Country : US
Telephone Number : 312-852-2241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2012
Last Update Date : 05/18/2012

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