Provider Demographics
NPI:1578619060
Name:CUEVAS, JORGE L (PHD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:CUEVAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE #407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5190
Mailing Address - Country:US
Mailing Address - Phone:773-296-5901
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE #407
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5190
Practice Address - Country:US
Practice Address - Phone:773-296-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical