Basic Information
| Provider Information | |||||||||
| NPI: | 1659718088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CACHRO | ||||||||
| FirstName: | KINGA | ||||||||
| MiddleName: | ANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7752 MOODY AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604591233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082370245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1414 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601603902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086810073 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | IL | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 149018371 | ID | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 149.018371 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.