Healthcare Provider Details

I. General information

NPI: 1912429200
Provider Name (Legal Business Name): CLARA F VILLASENOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 760A
CHICAGO IL
60601-7711
US

IV. Provider business mailing address

155 N MICHIGAN AVE STE 760A
CHICAGO IL
60601-7711
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-4088
  • Fax:
Mailing address:
  • Phone: 312-725-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018749
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.018749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: