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General NPI Number Information
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NPI Number | 1982369245
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Entity Type | Individual
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Provider Name | ANGELICA GUILLEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 509510
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 312-753-9465
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Fax | 773-442-0940
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Provider Business Mailing Address
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Address Line | 230 S POPLAR RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2844
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Country | US
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Telephone | 312-753-9465
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Fax | 773-442-0940
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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 | 149023275
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License Number State | IL
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