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General NPI Number Information
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NPI Number | 1043590342
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Entity Type | Organization
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Legal Business Name | CHICVARA & ASSOCIATES
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 19102 S BLACKHAWK PKWY SUITE 25E
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City | MOKENA
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State | IL
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Zip | 60448-8985
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Country | US
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Telephone | 708-473-2445
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Fax | 815-469-6666
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Provider Business Mailing Address
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Address Line | PO BOX 613
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City | CHANNAHON
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State | IL
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Zip | 60410-0613
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Country | US
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Telephone | 815-521-1889
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Fax | 815-521-1889
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE CHICVARA
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Credential | PSY.D.
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Telephone | 708-473-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008055
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License Number State | IL
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