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General NPI Number Information
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NPI Number | 1154194108
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Entity Type | Individual
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Provider Name | SHEENA CORDOVA LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 3501 E 106TH ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60617-6625
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Country | US
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Telephone | 888-417-0274
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Fax | 888-419-3986
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Provider Business Mailing Address
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Address Line | 440 N WABASH AVE APT 1908
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City | CHICAGO
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State | IL
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Zip | 60611-7642
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.025330
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License Number State | IL
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