MEDICARE: EMBRACE CORAZON COUNSELING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1184289118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE CORAZON COUNSELING PC

Provider Business Mailing Address
First Line	:	4045 W 58TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4432
Country	:	US
Telephone Number	:	773-988-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 W 18TH ST STE 216
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2400
Country	:	US
Telephone Number	:	708-581-8018
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/THERAPIST
Name	:	MS. SUSIE MOYA
Credential	:	LCSW
Telephone Number	:	708-581-8018

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	01/13/2022

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