Alza Great Lakes Psychotherapy Professional LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC

Practice address

1719 N Rutherford Ave
Chicago, IL 60707-3942

Phone

(708) 824-7533

Fax

(312) 748-4256

NPI assigned

Aug 30, 2024

Last updated

Feb 12, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ena Isis Milllward

Title

LCSW

Phone

(773) 707-6093

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ena Isis Millward, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1386477230
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1720812860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7061 NORTH AVE # 292",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021015",
            "telephone_number": "708-824-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 N RUTHERFORD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "607073942",
            "telephone_number": "708-824-7533",
            "fax_number": "312-748-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-30",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "MILLLWARD",
        "authorized_official_first_name": "ENA",
        "authorized_official_middle_name": "ISIS",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "773-707-6093"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.