Provider Demographics
NPI:1235704263
Name:ALFARO, LILIANA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:ELIZABETH
Last Name:ALFARO
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 1:6124 N ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2831
Mailing Address - Country:US
Mailing Address - Phone:773-754-6243
Mailing Address - Fax:
Practice Address - Street 1:3665 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4567
Practice Address - Country:US
Practice Address - Phone:773-754-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist