MEDICARE: ELSA MONTOTO VEGA 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	149.015412	IL

General Provider Information

NPI Number	:	1528476132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA MONTOTO VEGA LCSW

Provider Business Mailing Address
First Line	:	2318 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3520
Country	:	US
Telephone Number	:	773-550-3143
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	03/04/2024

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Directions to “ ELSA MONTOTO VEGA LCSW” Practice Location

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