MEDICARE: LOURDES CARVAJAL

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	149.041058	IL

General Provider Information

NPI Number	:	1396526273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES CARVAJAL

Provider Business Mailing Address
First Line	:	6427 N MAGNOLIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 W GRANVILLE AVE UNIT 5
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2156
Country	:	US
Telephone Number	:	773-335-3509
Fax Number	:	312-489-8138

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	03/19/2026

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Directions to “ LOURDES CARVAJAL ” Practice Location

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