Provider Demographics
NPI:1548378060
Name:TOMAS-TOLENTINO, GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:TOMAS-TOLENTINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 814
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-240-5080
Mailing Address - Fax:847-240-1977
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 814
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-240-5080
Practice Address - Fax:847-240-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14152Medicaid
IL14152Medicaid