Provider Demographics
NPI:1598498875
Name:AGUIRRE MTANOUS, NAHIME GUADALUPE (LSW)
Entity Type:Individual
Prefix:MISS
First Name:NAHIME
Middle Name:GUADALUPE
Last Name:AGUIRRE MTANOUS
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 1:1330 E 53RD ST APT 1321
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1070
Mailing Address - Country:US
Mailing Address - Phone:956-225-4735
Mailing Address - Fax:
Practice Address - Street 1:3001 N SOUTHPORT AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4289
Practice Address - Country:US
Practice Address - Phone:773-799-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150109151104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150109151OtherIDFPR LICENSED SOCIAL WORKER