Provider Demographics
NPI:1780262162
Name:TERMENA, SYLWIA
Entity type:Individual
Prefix:
First Name:SYLWIA
Middle Name:
Last Name:TERMENA
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 1:109 FAIRFIELD WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1500
Mailing Address - Country:US
Mailing Address - Phone:773-319-9158
Mailing Address - Fax:
Practice Address - Street 1:109 FAIRFIELD WAY STE 205
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1500
Practice Address - Country:US
Practice Address - Phone:773-319-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health