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General NPI Number Information
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NPI Number | 1851761092
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Entity Type | Organization
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Legal Business Name | BERYL-DENISE AGUILERA, MA, LMFTA
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 321 N CLARK ST SUITE 500
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City | CHICAGO
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State | IL
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Zip | 60654-4714
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Country | US
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Telephone | 312-445-6423
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N CLARK ST SUITE 500
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City | CHICAGO
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State | IL
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Zip | 60654-4714
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Country | US
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Telephone | 312-445-6423
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Fax |
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Authorized Official
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Title or Position | SR. THERAPIST
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Name | BERYL-DENISE AGUILERA
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Credential | MA, LMFTA
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Telephone | 312-445-6423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20800429
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License Number State | IL
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