Provider Demographics
NPI:1144627837
Name:FUENTES-PENA, CLAUDIA C (MSW, LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:C
Last Name:FUENTES-PENA
Suffix:
Gender:F
Credentials:MSW, LCSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4229
Mailing Address - Country:US
Mailing Address - Phone:312-602-1460
Mailing Address - Fax:312-733-5211
Practice Address - Street 1:1100 S MAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4229
Practice Address - Country:US
Practice Address - Phone:312-602-1460
Practice Address - Fax:312-733-5211
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1407971211101YM0800X
IL149.0265411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362170821019Medicaid