Provider Demographics
NPI:1669102802
Name:FAVELA, LINNEA (LCSW)
Entity type:Individual
Prefix:
First Name:LINNEA
Middle Name:
Last Name:FAVELA
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 1:12 SADDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9175
Mailing Address - Country:US
Mailing Address - Phone:630-299-6513
Mailing Address - Fax:
Practice Address - Street 1:13 S 2ND ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2283
Practice Address - Country:US
Practice Address - Phone:630-277-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0227191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty