Provider Demographics
NPI:1477384857
Name:FLORES, MARILYN DENISSE
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:DENISSE
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 W 67TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4129
Mailing Address - Country:US
Mailing Address - Phone:773-512-2501
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD STE 703
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1423
Practice Address - Country:US
Practice Address - Phone:773-312-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker