Healthcare Provider Details

I. General information

NPI: 1215187661
Provider Name (Legal Business Name): RICARDO AGUINAGA JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

IV. Provider business mailing address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

V. Phone/Fax

Practice location:
  • Phone: 773-836-2785
  • Fax:
Mailing address:
  • Phone: 708-836-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: