Basic Information
| Provider Information | |||||||||
| NPI: | 1598492183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARBOSA | ||||||||
| FirstName: | LUIZ | ||||||||
| MiddleName: | CARLOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5855 N GLENWOOD AVE APT 2N | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606605421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125369845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1723 HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602023735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2243078550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2022 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.011500 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.