Provider Demographics
NPI:1922690312
Name:FERNANDA MAYTORENA-UNGER
Entity Type:Organization
Organization Name:FERNANDA MAYTORENA-UNGER
Other - Org Name:RESILIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-280-0607
Mailing Address - Street 1:3547 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3848
Mailing Address - Country:US
Mailing Address - Phone:708-567-7342
Mailing Address - Fax:949-437-2647
Practice Address - Street 1:6925 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2248
Practice Address - Country:US
Practice Address - Phone:708-567-7342
Practice Address - Fax:949-437-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149022511OtherLCSW LICENSE
IL1518556778OtherNPI