Healthcare Provider Details

I. General information

NPI: 1326875436
Provider Name (Legal Business Name): CARMEN JUDITH CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/14/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE
CHICAGO IL
60603-3357
US

IV. Provider business mailing address

621 N CENTRAL PARK AVE
CHICAGO IL
60624-1240
US

V. Phone/Fax

Practice location:
  • Phone: 312-922-7474
  • Fax:
Mailing address:
  • Phone: 773-895-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: