Provider Demographics
NPI:1275394678
Name:JUAREZ DURAN, LAUREN GABRIELLE (MSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:GABRIELLE
Last Name:JUAREZ DURAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4657
Mailing Address - Country:US
Mailing Address - Phone:505-620-9839
Mailing Address - Fax:
Practice Address - Street 1:2807 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1221
Practice Address - Country:US
Practice Address - Phone:630-300-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-1293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty