Provider Demographics
NPI:1649935453
Name:KURDI-VILLATE, FARAH ALEXANDRA (AM, LCSW)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:ALEXANDRA
Last Name:KURDI-VILLATE
Suffix:
Gender:F
Credentials:AM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N WABASH AVE APT 4809
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7680
Mailing Address - Country:US
Mailing Address - Phone:773-505-0783
Mailing Address - Fax:
Practice Address - Street 1:440 N WABASH AVE APT 4809
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7680
Practice Address - Country:US
Practice Address - Phone:773-505-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL1501068621041C0700X
IL1490260101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical