Doctor Name: | JOSETTE HEREDIA-CARMONA |
NPI Number: | 1063784890 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149010344 |
Business Practice Address: | 6918 Windsor Ave Berwyn, IL - 604023334 |
Business Phone Number: | 7087455277 |
Business Fax Number: | 7087954834 |
Mailing Address: | 6918 Windsor Ave, BERWYN |
State: | IL |
Postal Code: | 604023334 |
Phone Number: | 7087455277 |
Fax Number: | 7087954834 |
NPI Enumeration Date: | 02/09/2012 |
NPI Last Update Date: | 02/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149010344 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |