Healthcare Provider Details

I. General information

NPI: 1467247502
Provider Name (Legal Business Name): EMILIA N BARAJAS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST STE 20
OAK PARK IL
60302-3159
US

IV. Provider business mailing address

1447 HARVEY AVE
BERWYN IL
60402-5760
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax:
Mailing address:
  • Phone: 708-378-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.116034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: