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ALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC
NPI 1720812860
Social Worker - Clinical in Chicago, IL

Active since August 30, 2024
1719 N RUTHERFORD AVE, CHICAGO, IL 60707(708) 824-7533(312) 748-4256 Get Directions Write a Review

NPPES record last updated: February 12, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 12, 2025, Sep 4, 2024 (2 updates tracked since 2024).

About Alza Great Lakes Psychotherapy Professional Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC (NPI 1720812860) is a healthcare organization registered as a clinical in Chicago, Illinois and active in the NPI registry since August 2024. The organization lists Ena Isis Milllward, Lcsw, as its authorized official.

NPPES Registry Identity

NPI1720812860
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC
Location Address1719 N RUTHERFORD AVEChicago, IL 60707-3942
Mailing Address7061 North Ave # 292Oak Park, IL 60302-1015 · (708) 824-7533
Phone(708) 824-7533
Fax(312) 748-4256
Organization SubpartNo
Authorized OfficialEna Isis MilllwardLcsw · (773) 707-6093
Enumeration DateAugust 30, 2024
Last NPPES UpdateFebruary 12, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 12, 2025
✔ NPI 1720812860 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
1719 N RUTHERFORD AVE, Chicago, IL 60707
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alza Great Lakes Psychotherapy Professional Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Alza Great Lakes Psychotherapy Professional LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Ena Millward, LCSW
Clinical Social Worker
NPI 1386477230
1719 N RUTHERFORD AVE
Chicago, IL 60707
(773) 707-6093
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alza Great Lakes Psychotherapy Professional LLC's NPI number?

The NPI number for Alza Great Lakes Psychotherapy Professional LLC is 1720812860. It was assigned to this organization in the NPPES registry on August 30, 2024.

Where is Alza Great Lakes Psychotherapy Professional LLC located?

Alza Great Lakes Psychotherapy Professional LLC is located at 1719 N Rutherford Ave, Chicago, IL 60707. The listed phone number is (708) 824-7533.

What is Alza Great Lakes Psychotherapy Professional LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Alza Great Lakes Psychotherapy Professional LLC enrolled in Medicare?

Yes. Alza Great Lakes Psychotherapy Professional LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Alza Great Lakes Psychotherapy Professional LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Social Worker) reassigns their Medicare billing to Alza Great Lakes Psychotherapy Professional LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Alza Great Lakes Psychotherapy Professional LLC was last updated on February 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.