Provider Demographics
NPI:1932599503
Name:ANDRADE, ALEJANDRO LUNA JR
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:LUNA
Last Name:ANDRADE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60690-0103
Mailing Address - Country:US
Mailing Address - Phone:312-307-9875
Mailing Address - Fax:
Practice Address - Street 1:465 CENTRAL AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3045
Practice Address - Country:US
Practice Address - Phone:847-686-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical