Healthcare Provider Details

I. General information

NPI: 1376390807
Provider Name (Legal Business Name): ESTHER DECERO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W MADISON ST STE 302
CHICAGO IL
60607-2191
US

IV. Provider business mailing address

2424 N CLARK ST APT 405
CHICAGO IL
60614-2702
US

V. Phone/Fax

Practice location:
  • Phone: 312-324-4502
  • Fax:
Mailing address:
  • Phone: 480-467-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: