Provider Demographics
NPI:1689817587
Name:CHICVARA, JULIE ANNE (PSYD, LCP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:CHICVARA
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:14923 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3424
Mailing Address - Country:US
Mailing Address - Phone:708-473-2445
Mailing Address - Fax:708-966-4363
Practice Address - Street 1:20635 ABBEY WOODS CT N
Practice Address - Street 2:SUITE 207
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3181
Practice Address - Country:US
Practice Address - Phone:708-473-2445
Practice Address - Fax:708-966-4363
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006050101YP2500X
IL071008055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBC/BS