Provider Demographics
NPI:1871029454
Name:CHESTEK, JOYCE MARA DAMASCENO (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARA DAMASCENO
Last Name:CHESTEK
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 W RANDOLPH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2218
Mailing Address - Country:US
Mailing Address - Phone:774-260-2021
Mailing Address - Fax:
Practice Address - Street 1:564 W RANDOLPH ST
Practice Address - Street 2:SUITE 247
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2218
Practice Address - Country:US
Practice Address - Phone:773-896-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011965101YP2500X
IL180.011256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional