Provider Demographics
NPI:1609690148
Name:ATILANO, VIVIANA GUTIERREZ (MSW LCSW)
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:GUTIERREZ
Last Name:ATILANO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 TOMAHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1135
Mailing Address - Country:US
Mailing Address - Phone:224-944-8042
Mailing Address - Fax:
Practice Address - Street 1:1832 TOMAHAWK TRL
Practice Address - Street 2:
Practice Address - City:ROUND LAKE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60073-1135
Practice Address - Country:US
Practice Address - Phone:224-944-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical