Healthcare Provider Details

I. General information

NPI: 1174251086
Provider Name (Legal Business Name): ANGELICA DANNI BARBOSA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N LOOMIS ST
CHICAGO IL
60607-1147
US

IV. Provider business mailing address

310 N LOOMIS ST
CHICAGO IL
60607-1147
US

V. Phone/Fax

Practice location:
  • Phone: 312-733-0883
  • Fax:
Mailing address:
  • Phone: 312-773-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150108603
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: