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General NPI Number Information
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NPI Number | 1366077877
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Entity Type | Individual
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Provider Name | GENESIS GUADALUPE GALAN CRUZ
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Gender | Female
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 6918 W WINDSOR AVE
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City | BERWYN
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State | IL
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Zip | 60402-3334
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Country | US
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Telephone | 708-745-5277
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 EAST AVE
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3133
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Country | US
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Telephone | 708-745-5277
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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 | 149028876
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License Number State | IL
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