Provider Demographics
NPI:1508995812
Name:GUILLERMO, JUANITA (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 N WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2515
Mailing Address - Country:US
Mailing Address - Phone:773-267-7819
Mailing Address - Fax:
Practice Address - Street 1:4223 N WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2515
Practice Address - Country:US
Practice Address - Phone:773-267-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical