Healthcare Provider Details

I. General information

NPI: 1285812925
Provider Name (Legal Business Name): JAIME ESQUIVEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W PETERSON AVE C4
CHICAGO IL
60659-4108
US

IV. Provider business mailing address

1419 W FARRAGUT AVE
CHICAGO IL
60640-2103
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-2525
  • Fax: 773-765-0622
Mailing address:
  • Phone: 773-293-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014660
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: