Provider Demographics
NPI:1942932819
Name:VILLA, MARISOL (LSW)
Entity Type:Individual
Prefix:MS
First Name:MARISOL
Middle Name:
Last Name:VILLA
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 1:1 E. SUPERIOR ST.
Mailing Address - Street 2:#306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2595
Mailing Address - Country:US
Mailing Address - Phone:312-754-9404
Mailing Address - Fax:
Practice Address - Street 1:1 E. SUPERIOR ST.
Practice Address - Street 2:#306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2595
Practice Address - Country:US
Practice Address - Phone:312-754-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107943104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker