Provider Demographics
NPI:1528206216
Name:SUAREZ, IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:SUAREZ
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 1:5730 N OCTAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3064
Mailing Address - Country:US
Mailing Address - Phone:773-594-9254
Mailing Address - Fax:773-594-9254
Practice Address - Street 1:5730 N OCTAVIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3064
Practice Address - Country:US
Practice Address - Phone:773-594-9254
Practice Address - Fax:773-594-9254
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0134191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical