Healthcare Provider Details

I. General information

NPI: 1518885011
Provider Name (Legal Business Name): SANDRA MOSCOSO-FRIEDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 22ND ST STE 158
LOMBARD IL
60148-6175
US

IV. Provider business mailing address

118 S PRAIRIE AVE
BLOOMINGDALE IL
60108-1608
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-3900
  • Fax:
Mailing address:
  • Phone: 630-965-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: