| Kelly Vierra, Lcsw, Llc | |
|
4043 N Ravenswood Ave Ste 306d Chicago IL 60613-5683 | |
| (773) 807-8474 | |
| Not Available |
| Full Name | Kelly Vierra, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4043 N Ravenswood Ave Ste 306d, Chicago, Illinois |
| Authorized Official Name and Position | Kelly Vierra (CLINICAL THERAPIST) |
| Authorized Official Contact | 7738078474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Vierra, Lcsw, Llc 4043 N Ravenswood Ave Ste 306d Chicago IL 60613-5683 Ph: (773) 807-8474 | Kelly Vierra, Lcsw, Llc 4043 N Ravenswood Ave Ste 306d Chicago IL 60613-5683 Ph: (773) 807-8474 |
| NPI Number | 1326696154 |
|---|---|
| Provider Enumeration Date | 08/26/2019 |
| Last Update Date | 04/14/2022 |
| Certification Date | 04/14/2022 |
| Medicare PECOS PAC ID | 8820420318 |
|---|---|
| Medicare Enrollment ID | O20191121002981 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326696154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelly S Vierra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609282227 PECOS PAC ID: 6305064908 Enrollment ID: I20140822002101 |
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