Healthcare Provider Details

I. General information

NPI: 1578490371
Provider Name (Legal Business Name): MELINA D. WORCESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E ONTARIO ST
CHICAGO IL
60611-2874
US

IV. Provider business mailing address

142 E ONTARIO ST
CHICAGO IL
60611-2874
US

V. Phone/Fax

Practice location:
  • Phone: 312-229-0446
  • Fax:
Mailing address:
  • Phone: 312-229-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178022857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: