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NPI Code Detail

MEDICARE: CAMILA RICHMOND LSW

MEDICARE: CAMILA RICHMOND LSW
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
1101YP2500XProfessional Counselor150104554IL
2101YP2500XProfessional Counselor150.104554IL
3101YP2500XProfessional Counselor149024272IL

General Provider Information

NPI Number : 1730793597
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILA RICHMOND LSW
Provider Business Mailing Address
First Line : 1922 S TROY ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60623-2294
Country : US
Telephone Number : 646-276-4825
Fax Number :
Provider Business Practice Location Address
First Line : 414 PLAZA DR STE 301
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5508
Country : US
Telephone Number : 630-728-1744
Fax Number : 630-998-7029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2020
Last Update Date : 03/13/2023

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Directions to “ CAMILA RICHMOND LSW” Practice Location

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