Provider Demographics
NPI:1174303358
Name:AVILA, AMBER MARIE (LSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:AVILA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:SAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1039 TOWNER DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1653
Mailing Address - Country:US
Mailing Address - Phone:630-863-5775
Mailing Address - Fax:
Practice Address - Street 1:212 S MARION ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3257
Practice Address - Country:US
Practice Address - Phone:312-415-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.111676104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker