Provider Demographics
NPI:1023683091
Name:MARRUFO, ANGELICA MARIA (LCPC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:MARRUFO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 N SEELEY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1450
Mailing Address - Country:US
Mailing Address - Phone:773-569-6054
Mailing Address - Fax:
Practice Address - Street 1:7461 N SEELEY AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1450
Practice Address - Country:US
Practice Address - Phone:773-569-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty