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NPI Code Detail

MEDICARE: LETICIA GUITRON MSW, LCSW, ICDVP

MEDICARE: LETICIA GUITRON MSW, LCSW, ICDVP
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
11041C0700XClinical Social Worker149020082IL

General Provider Information

NPI Number : 1619534088
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETICIA GUITRON MSW, LCSW, ICDVP
Provider Business Mailing Address
First Line : 3843 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4623
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3843 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4623
Country : US
Telephone Number : 773-884-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2019
Last Update Date : 05/21/2019

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