Healthcare Provider Details

I. General information

NPI: 1073844593
Provider Name (Legal Business Name): EVE AUGUSTA ESCALANTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 N. MARCEY SUITE 535 TERRY HEFTER ASSOCIATES, LLC
CHICAGO IL
60614-7965
US

IV. Provider business mailing address

1731 N. MARCEY SUITE 535 TERRY HEFTER ASSOCIATES, LLC
CHICAGO IL
60614-7965
US

V. Phone/Fax

Practice location:
  • Phone: 312-280-1166
  • Fax: 312-280-1199
Mailing address:
  • Phone: 312-280-1166
  • Fax: 312-280-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.013821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: