MEDICARE: ANDREA CAROLINA ESPINOSA 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	149.023944	IL

General Provider Information

NPI Number	:	1700541323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CAROLINA ESPINOSA LCSW

Provider Business Mailing Address
First Line	:	4043 N RAVENSWOOD AVE STE 302
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5683
Country	:	US
Telephone Number	:	312-967-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4043 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1155
Country	:	US
Telephone Number	:	312-967-4669
Fax Number	:

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

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	02/22/2022

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