Healthcare Provider Details

I. General information

NPI: 1235007618
Provider Name (Legal Business Name): OMAR IVAN ALBA VALDEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 W BELMONT AVE
CHICAGO IL
60634-4384
US

IV. Provider business mailing address

3405 N PARIS AVE
CHICAGO IL
60634-2936
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-1830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: