Aide Fonseca, LCSW
Individual provider Active NPI Clinical Social Worker · Hillside, IL
NPI 1073103602 · NPPES record last updated Jan 18, 2021
Key facts
- NPI
- 1073103602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149021200 (IL)
- Practice address
- 4531 Idlewild LN
Hillside, IL 60162-1755 - Phone
- (708) 846-4812
- NPI assigned
- Jan 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149021200 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149021200 | IL | Yes |
Addresses
Primary practice location
4531 Idlewild LN
Hillside, IL 60162-1755
Mailing address
4531 Idlewild LN
Hillside, IL 60162-1755
Phone (708) 846-4812
Other providers in Hillside, IL
- Keith Destefano
- Barbara A. Dipaolo
- Jill Marie Dolan
- Emily Ann Duszynski
- Jade Fields
- Michelle Nicole Fry
- Christopher Fuller
- Marni Garfinkel
- Christian Gaubatz
- Genesis Residential Living and Home Healthcare, Inc.
All providers in Hillside, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.