Provider Demographics
NPI:1861040305
Name:RUVALCABA, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:RUVALCABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 N WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3521
Mailing Address - Country:US
Mailing Address - Phone:773-971-7528
Mailing Address - Fax:
Practice Address - Street 1:3819 N WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3521
Practice Address - Country:US
Practice Address - Phone:773-971-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-02-09
Deactivation Date:2020-10-13
Deactivation Code:
Reactivation Date:2021-02-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health