Healthcare Provider Details

I. General information

NPI: 1962896456
Provider Name (Legal Business Name): MAYRA TERESA GALARZA ACOSTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 S RANDALL RD STE 1180
ELGIN IL
60123-5529
US

IV. Provider business mailing address

244 S RANDALL RD # 1180
ELGIN IL
60123-5529
US

V. Phone/Fax

Practice location:
  • Phone: 773-455-0909
  • Fax:
Mailing address:
  • Phone: 773-455-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027221
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: