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General NPI Number Information
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NPI Number | 1619441656
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Entity Type | Individual
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Provider Name | NATASHA D CEBALLOS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 5547 N RAVENSWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60640-1125
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Country | US
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Telephone | 314-200-5951
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 314-200-5951
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2018029407
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License Number State | MO
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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 | 149.024282
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License Number State | IL
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