MEDICARE: ANA C CHAVEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.019594	IL

General Provider Information

NPI Number	:	1134646615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA C CHAVEZ LCSW

Provider Business Mailing Address
First Line	:	1653 W 35TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1309
Country	:	US
Telephone Number	:	773-980-6784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629
Country	:	US
Telephone Number	:	773-980-6784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	05/11/2026

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