Provider Demographics
NPI:1215402193
Name:TOVAR VEGA, RICARDO (QMHP, MSW,)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:TOVAR VEGA
Suffix:
Gender:M
Credentials:QMHP, MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W OAKDALE AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5914
Mailing Address - Country:US
Mailing Address - Phone:773-642-6069
Mailing Address - Fax:
Practice Address - Street 1:441 W OAKDALE AVE APT 3D1206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5961
Practice Address - Country:US
Practice Address - Phone:773-642-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2235147Medicaid