Provider Demographics
NPI:1033432687
Name:MARAVILLAS, OSCAR J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:J
Last Name:MARAVILLAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 N. ALBANY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:312-561-6914
Mailing Address - Fax:
Practice Address - Street 1:6033 N. SHERIDAN RD.
Practice Address - Street 2:SUITE 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:312-566-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2018-08-06
Deactivation Date:2013-08-29
Deactivation Code:
Reactivation Date:2017-11-16
Provider Licenses
StateLicense IDTaxonomies
IL1490139271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical