Provider Demographics
NPI:1548561541
Name:VARDI, SHIRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHIRA
Middle Name:
Last Name:VARDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 W LELAND AVE
Mailing Address - Street 2:FIRST FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1513
Mailing Address - Country:US
Mailing Address - Phone:608-334-2991
Mailing Address - Fax:
Practice Address - Street 1:2007 W LELAND AVE
Practice Address - Street 2:FIRST FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1513
Practice Address - Country:US
Practice Address - Phone:608-334-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0138031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical