Provider Demographics
NPI:1093471146
Name:ARROYO, SAMANTHA JULIE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JULIE
Last Name:ARROYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1918
Mailing Address - Country:US
Mailing Address - Phone:773-504-4076
Mailing Address - Fax:
Practice Address - Street 1:8 S MICHIGAN AVE FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:630-686-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNKNOWNOtherBLUE CROSS BLUE SHIELD