Provider Demographics
NPI:1487148730
Name:BARAJAS, EDDY
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 S LAKE PARK AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4534
Mailing Address - Country:US
Mailing Address - Phone:312-375-6990
Mailing Address - Fax:
Practice Address - Street 1:5341 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2892
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty