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General NPI Number Information
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NPI Number | 1144627837
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Entity Type | Individual
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Provider Name | CLAUDIA C FUENTES-PENA MSW, LCSW, QMHP
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1100 S MAY ST
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City | CHICAGO
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State | IL
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Zip | 60607-4229
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Country | US
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Telephone | 312-602-1460
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Fax | 312-733-5211
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Provider Business Mailing Address
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Address Line | 1100 S MAY ST
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City | CHICAGO
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State | IL
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Zip | 60607-4229
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Country | US
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Telephone | 312-602-1460
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Fax | 312-733-5211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1407971211
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.026541
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License Number State | IL
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