MEDICARE: VALERIE GUERRA 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	104100000X	Social Worker	150014760	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150014760	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1912450370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE GUERRA LSW

Provider Business Mailing Address
First Line	:	3048 N WILTON AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60657-6710
Country	:	US
Telephone Number	:	773-296-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6631 N BOSWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4223
Country	:	US
Telephone Number	:	773-296-7544
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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Directions to “ VALERIE GUERRA LSW” Practice Location

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