Provider Demographics
NPI:1003452541
Name:SEPULVEDA, BLANCA E (LCSW)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:E
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 W 18TH PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2531
Mailing Address - Country:US
Mailing Address - Phone:773-895-3128
Mailing Address - Fax:
Practice Address - Street 1:50 E WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2142
Practice Address - Country:US
Practice Address - Phone:312-252-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0213511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical