Healthcare Provider Details

I. General information

NPI: 1568001337
Provider Name (Legal Business Name): ERICA NAVARRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 W IRVING PARK RD
CHICAGO IL
60641-2718
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603-2420
US

V. Phone/Fax

Practice location:
  • Phone: 773-724-6200
  • Fax: 773-866-8015
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019803
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: