Provider Demographics
NPI:1881140408
Name:LAVERDE, YEFERSON (MSW, QMHP)
Entity type:Individual
Prefix:
First Name:YEFERSON
Middle Name:
Last Name:LAVERDE
Suffix:
Gender:M
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 W 69TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4209
Mailing Address - Country:US
Mailing Address - Phone:773-875-0970
Mailing Address - Fax:
Practice Address - Street 1:3062 EAST 31ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-371-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical