MEDICARE: THELMA RAZO LSW

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	149028761	IL

General Provider Information

NPI Number	:	1851985899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THELMA RAZO LSW

Provider Business Mailing Address
First Line	:	34 N ISLAND AVE STE F
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-1996
Country	:	US
Telephone Number	:	630-601-3458
Fax Number	:	331-422-2912

Provider Business Practice Location Address
First Line	:	34 N ISLAND AVE STE F
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-1996
Country	:	US
Telephone Number	:	630-301-3458
Fax Number	:

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

Provider Enumeration Date	:	02/20/2021
Last Update Date	:	09/19/2025

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