MEDICARE: ALVINNETTA BURKS 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	149-003231	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149-3231	OTHER	IL	LICENSED CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1801163365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVINNETTA BURKS LCSW,

Provider Business Mailing Address
First Line	:	1335 S PRAIRIE AVE
Second Line	:	UNIT 608
City	:	CHICAGO
State	:	IL
Zip	:	60605-3121
Country	:	US
Telephone Number	:	708-846-9195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 S PRAIRIE AVE
Second Line	:	UNIT 608
City	:	CHICAGO
State	:	IL
Zip	:	60605-3121
Country	:	US
Telephone Number	:	708-846-9195
Fax Number	:

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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