Provider Demographics
NPI:1720239205
Name:CABANAS, THERESA (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:CABANAS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 W 64TH PL
Mailing Address - Street 2:UNIT 6
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5336
Mailing Address - Country:US
Mailing Address - Phone:773-987-8165
Mailing Address - Fax:
Practice Address - Street 1:2528 N LINCOLN AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2333
Practice Address - Country:US
Practice Address - Phone:773-987-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0157791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical