Healthcare Provider Details

I. General information

NPI: 1780503904
Provider Name (Legal Business Name): MILENA MARINA TESI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

IV. Provider business mailing address

1015 W BUENA AVE APT 4E
CHICAGO IL
60613-6409
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax: 708-681-3958
Mailing address:
  • Phone: 708-681-0073
  • Fax: 708-681-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150119382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: