Healthcare Provider Details

I. General information

NPI: 1659294635
Provider Name (Legal Business Name): DAVID DELGADO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 N NEWLAND AVE
CHICAGO IL
60707-2985
US

IV. Provider business mailing address

2316 N NEWLAND AVE
CHICAGO IL
60707-2985
US

V. Phone/Fax

Practice location:
  • Phone: 872-305-1635
  • Fax:
Mailing address:
  • Phone: 872-305-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.130021
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: