Healthcare Provider Details

I. General information

NPI: 1720598618
Provider Name (Legal Business Name): CSILLA BOKOR MEGYERI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE STE F101
CHICAGO IL
60625-0035
US

IV. Provider business mailing address

5215 N CALIFORNIA AVE STE F101
CHICAGO IL
60625-0035
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-5809
  • Fax: 773-561-5946
Mailing address:
  • Phone: 773-561-5809
  • Fax: 773-561-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019692
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: