MEDICARE: LAURA LILIANA SEVILLA LCSW

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	149.024923	IL

General Provider Information

NPI Number	:	1205719549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LILIANA SEVILLA LCSW

Provider Business Mailing Address
First Line	:	2253 W 24TH ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4279
Country	:	US
Telephone Number	:	708-220-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2253 W 24TH ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4279
Country	:	US
Telephone Number	:	708-220-6313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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