Healthcare Provider Details

I. General information

NPI: 1225640139
Provider Name (Legal Business Name): JUAN MIGUEL TORRES CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

1838 W HURON ST
CHICAGO IL
60622-5523
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-1093
  • Fax:
Mailing address:
  • Phone: 619-379-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.107001
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: