Provider Demographics
NPI:1073357455
Name:LLARENA-ANGARA, MIA R (MAT)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:R
Last Name:LLARENA-ANGARA
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:R
Other - Last Name:ANGARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2104 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4816
Mailing Address - Country:US
Mailing Address - Phone:312-502-8868
Mailing Address - Fax:
Practice Address - Street 1:7250 N CICERO AVE STE 220
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1627
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor