Healthcare Provider Details

I. General information

NPI: 1013827047
Provider Name (Legal Business Name): ANGELA M LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 W BERTEAU AVE STE 304
CHICAGO IL
60613-6131
US

IV. Provider business mailing address

4455 N HERMITAGE AVE UNIT I
CHICAGO IL
60640-3024
US

V. Phone/Fax

Practice location:
  • Phone: 312-248-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: