Provider Demographics
NPI:1902260623
Name:EUGENIO-VIRONET, ERIC (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:EUGENIO-VIRONET
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:VIRONET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9649 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3632
Mailing Address - Country:US
Mailing Address - Phone:708-352-3580
Mailing Address - Fax:708-352-2715
Practice Address - Street 1:9649 W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3632
Practice Address - Country:US
Practice Address - Phone:708-352-3580
Practice Address - Fax:708-352-2715
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2017-07-13
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
IL$$$$$$$$$001Medicaid