Provider Demographics
NPI:1992387880
Name:CONTRERAS-DARDON, CECILIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:
Last Name:CONTRERAS-DARDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16717 W PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7625
Mailing Address - Country:US
Mailing Address - Phone:708-715-4349
Mailing Address - Fax:
Practice Address - Street 1:1030 S LA GRANGE RD STE 9
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2893
Practice Address - Country:US
Practice Address - Phone:708-921-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0216921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical