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General NPI Number Information
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NPI Number | 1538232442
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Entity Type | Individual
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Provider Name | ANGELA HERNANDEZ IANAKIEV LCSW, CADC, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 2700 KESLINGER RD STE B
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City | GENEVA
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State | IL
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Zip | 60134-4645
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Country | US
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Telephone | 307-653-2146
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Fax | 630-448-5169
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Provider Business Mailing Address
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Address Line | 43W043 CAMPTON HILLS RD
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City | ELBURN
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State | IL
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Zip | 60119-9435
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Country | US
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Telephone | 815-980-6740
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23399
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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 | 149015410
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License Number State | IL
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