Organization
CHICAGO MIDWAY YOUTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA MOSQUEDA LCSW (BEHAVIORAL HEALTH THERAPIST)
(773) 742-5728
Entity
Organization
Contact information
Practice address
4051 W 63RD ST, CHICAGO, IL 60629-4638
(773) 742-5728
Mailing address
725 9TH AVE, LA GRANGE, IL 60525-6728
(773) 742-5728
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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