Provider Demographics
NPI:1669570065
Name:URZUA, EDGAR (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:URZUA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2918
Mailing Address - Country:US
Mailing Address - Phone:847-718-7782
Mailing Address - Fax:847-718-7773
Practice Address - Street 1:2121 S GOEBBERT RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4205
Practice Address - Country:US
Practice Address - Phone:847-718-7782
Practice Address - Fax:847-718-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical