Healthcare Provider Details

I. General information

NPI: 1811373137
Provider Name (Legal Business Name): SANDRA VIEYRA-KAPUSNIAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

3006 N NORMANDY AVE
CHICAGO IL
60634-4819
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8462
  • Fax: 312-569-8986
Mailing address:
  • Phone: 773-615-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: