MEDICARE: RAQUEL MARIE SEGOVIA

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	150.109331	IL

General Provider Information

NPI Number	:	1386424224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL MARIE SEGOVIA

Provider Business Mailing Address
First Line	:	6321 N AVONDALE AVE STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1961
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:	773-774-4447

Provider Business Practice Location Address
First Line	:	6321 N AVONDALE AVE STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1961
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:	773-774-4447

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

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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Directions to “ RAQUEL MARIE SEGOVIA ” Practice Location

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