Provider Demographics
NPI:1083125033
Name:PECYNA, ANNA (LSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PECYNA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:PECYNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5425 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2342
Mailing Address - Country:US
Mailing Address - Phone:773-378-3347
Mailing Address - Fax:773-378-4028
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-378-3347
Practice Address - Fax:773-378-4028
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102646104100000X
IL1490210521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker