Provider Demographics
NPI:1699762872
Name:LEDESMA, BEATRIZ ELISABET (ATR LCPC)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ELISABET
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:ATR LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MICHIGAN AVE
Mailing Address - Street 2:STE 609
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:773-561-0825
Mailing Address - Fax:
Practice Address - Street 1:410 S MICHIGAN AVE
Practice Address - Street 2:STE 609
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605
Practice Address - Country:US
Practice Address - Phone:773-561-0825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622289OtherBLUE CROSS BLUE SHIELD