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General NPI Number Information
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NPI Number | 1548797558
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Entity Type | Individual
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Provider Name | CRISTINA CAMARAS LIEBERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 2650 W MONTROSE AVE STE 307
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City | CHICAGO
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State | IL
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Zip | 60618-1561
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Country | US
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Telephone | 773-712-5584
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Fax |
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Provider Business Mailing Address
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Address Line | 3851 W BERTEAU AVE APT 3B
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City | CHICAGO
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State | IL
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Zip | 60618-1944
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Country | US
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Telephone | 773-712-5584
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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 | 149020318
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150102207
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License Number State | IL
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