Provider Demographics
NPI:1588338461
Name:QUEROL, CHRISTY (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:QUEROL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 W DIVERSEY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1221
Mailing Address - Country:US
Mailing Address - Phone:786-325-3006
Mailing Address - Fax:
Practice Address - Street 1:3432 W DIVERSEY AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1221
Practice Address - Country:US
Practice Address - Phone:312-380-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical