Provider Demographics
NPI:1548044589
Name:CRISTIANO-HERNANDEZ, EDUARDO MAURICIO
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:MAURICIO
Last Name:CRISTIANO-HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 W BELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2801
Mailing Address - Country:US
Mailing Address - Phone:773-988-6688
Mailing Address - Fax:
Practice Address - Street 1:700 N GREEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5996
Practice Address - Country:US
Practice Address - Phone:773-234-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IL178020780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist