Individual
MIO NOMURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4853 N ASHLAND AVE, CHICAGO, IL 60640-3412
(773) 405-2862
Mailing address
4853 N ASHLAND AVE, CHICAGO, IL 60640-3412
(773) 405-2862
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149016072
IL
1041C0700X
Clinical Social Worker
149016072
IL
Other
Enumeration date
08/11/2014
Last updated
02/21/2019
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