Provider Demographics
NPI:1558922278
Name:MORENO, HILLARY BUZAID
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:BUZAID
Last Name:MORENO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N GREEN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5996
Mailing Address - Country:US
Mailing Address - Phone:312-620-8836
Mailing Address - Fax:
Practice Address - Street 1:2348 S RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3027
Practice Address - Country:US
Practice Address - Phone:773-726-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1881081263Medicaid