Provider Demographics
NPI:1194557645
Name:CABALLERO BOLANOS, DIANA YARELI (MA)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:YARELI
Last Name:CABALLERO BOLANOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ATKINSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7801
Mailing Address - Country:US
Mailing Address - Phone:847-441-5600
Mailing Address - Fax:847-441-7968
Practice Address - Street 1:100 N ATKINSON RD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7801
Practice Address - Country:US
Practice Address - Phone:847-441-5600
Practice Address - Fax:847-441-7968
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health