Provider Demographics
NPI:1932858339
Name:TELLEZ, PATRICIA (LSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 S SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2332
Mailing Address - Country:US
Mailing Address - Phone:312-619-1705
Mailing Address - Fax:
Practice Address - Street 1:3738 S SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2332
Practice Address - Country:US
Practice Address - Phone:312-619-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker