Provider Demographics
NPI:1396957346
Name:SHAPIRO, AVIS G (LCSW)
Entity type:Individual
Prefix:MS
First Name:AVIS
Middle Name:G
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1335 N ASTOR ST
Mailing Address - Street 2:10A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2152
Mailing Address - Country:US
Mailing Address - Phone:312-259-3083
Mailing Address - Fax:312-932-8997
Practice Address - Street 1:2024 HICKORY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2125
Practice Address - Country:US
Practice Address - Phone:312-259-3083
Practice Address - Fax:312-932-8997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical