Provider Demographics
NPI:1437163102
Name:SANCHEZ, GLORIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S ARDMORE AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4903
Mailing Address - Country:US
Mailing Address - Phone:630-525-0113
Mailing Address - Fax:
Practice Address - Street 1:1500 S ARDMORE AVE APT 212
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-4903
Practice Address - Country:US
Practice Address - Phone:630-525-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0089711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208173Medicare PIN