Provider Demographics
NPI:1043590342
Name:CHICVARA & ASSOCIATES
Entity type:Organization
Organization Name:CHICVARA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICVARA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-473-2445
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-0613
Mailing Address - Country:US
Mailing Address - Phone:815-521-1889
Mailing Address - Fax:815-521-1889
Practice Address - Street 1:19102 S BLACKHAWK PKWY
Practice Address - Street 2:SUITE 25E
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8985
Practice Address - Country:US
Practice Address - Phone:708-473-2445
Practice Address - Fax:815-469-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty