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General NPI Number Information
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NPI Number | 1811433881
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Entity Type | Individual
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Provider Name | MARIA CECILIA BOCANEGRA LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1609 SHERMAN AVE STE 207
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City | EVANSTON
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State | IL
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Zip | 60201-3753
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Country | US
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Telephone | 773-398-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 5209 N GLENWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60640-2216
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Country | US
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Telephone | 773-398-5903
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180010083
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License Number State | IL
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