Provider Demographics
NPI:1477235158
Name:VILLA, NATALIA BERENICE (LSW)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:BERENICE
Last Name:VILLA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6149 S KENNETH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5209
Mailing Address - Country:US
Mailing Address - Phone:773-581-4356
Mailing Address - Fax:773-498-7186
Practice Address - Street 1:6149 S KENNETH AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5209
Practice Address - Country:US
Practice Address - Phone:773-581-4356
Practice Address - Fax:773-498-7186
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker