Provider Demographics
NPI:1073267290
Name:JUAREZ, ELEANOR ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:ELIZABETH
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 W 57TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2141
Mailing Address - Country:US
Mailing Address - Phone:612-619-1976
Mailing Address - Fax:
Practice Address - Street 1:10343 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2410
Practice Address - Country:US
Practice Address - Phone:773-340-2329
Practice Address - Fax:708-974-3845
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-010488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical