Provider Demographics
NPI:1184804627
Name:ZARAGOZA-DIESFELD, YOLANDA PERAZA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:PERAZA
Last Name:ZARAGOZA-DIESFELD
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 1:916 W BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4407
Mailing Address - Country:US
Mailing Address - Phone:773-868-6824
Mailing Address - Fax:773-868-6828
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-868-6824
Practice Address - Fax:773-868-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health