Healthcare Provider Details

I. General information

NPI: 1184804627
Provider Name (Legal Business Name): YOLANDA PERAZA ZARAGOZA-DIESFELD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W IRVING PARK RD SUITE 203
CHICAGO IL
60613-3011
US

IV. Provider business mailing address

916 W BARRY AVE
CHICAGO IL
60657-4407
US

V. Phone/Fax

Practice location:
  • Phone: 773-868-6824
  • Fax: 773-868-6828
Mailing address:
  • Phone: 773-868-6824
  • Fax: 773-868-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: