Provider Demographics
NPI:1982369245
Name:GUILLEN, ANGELICA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2844
Mailing Address - Country:US
Mailing Address - Phone:312-753-9465
Mailing Address - Fax:773-442-0940
Practice Address - Street 1:1300 W BELMONT AVE STE 509510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:312-753-9465
Practice Address - Fax:773-442-0940
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490232751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical