Healthcare Provider Details

I. General information

NPI: 1104734482
Provider Name (Legal Business Name): DALE JAY DITTO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S ARLINGTON HEIGHTS RD STE 116
ARLINGTON HEIGHTS IL
60005-4142
US

IV. Provider business mailing address

918 W WINONA ST APT 601
CHICAGO IL
60640-6347
US

V. Phone/Fax

Practice location:
  • Phone: 847-666-5339
  • Fax: 847-637-5479
Mailing address:
  • Phone: 559-720-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.041933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: