Provider Demographics
NPI:1144308172
Name:CORRE, RAQUEL LOLITA (MSW)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:LOLITA
Last Name:CORRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 N TOWER CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3217
Mailing Address - Country:US
Mailing Address - Phone:847-606-9110
Mailing Address - Fax:
Practice Address - Street 1:6611 N TOWER CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3217
Practice Address - Country:US
Practice Address - Phone:847-606-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490001691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213512Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORK