Provider Demographics
NPI:1285303123
Name:MENA, BIANCA IVETTE (LCSW)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:IVETTE
Last Name:MENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 S MONITOR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1518
Mailing Address - Country:US
Mailing Address - Phone:773-580-5335
Mailing Address - Fax:
Practice Address - Street 1:2219 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3504
Practice Address - Country:US
Practice Address - Phone:773-325-7780
Practice Address - Fax:773-325-7781
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0232271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical