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NPI Code Detail

MEDICARE: MR. JAIME ZAVALA LCSW

MEDICARE: MR. JAIME ZAVALA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149018470IL

General Provider Information

NPI Number : 1851970396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAIME ZAVALA LCSW
Provider Business Mailing Address
First Line : 1007 W 19TH ST APT 2F
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4397
Country : US
Telephone Number : 312-342-2134
Fax Number :
Provider Business Practice Location Address
First Line : 2319 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4209
Country : US
Telephone Number : 773-322-6221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2021
Last Update Date : 04/02/2021

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