Healthcare Provider Details

I. General information

NPI: 1447302427
Provider Name (Legal Business Name): ZAREENA KHESHGI PHD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZAREENA KHESHGI PHD LCSW

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 N LINCOLN AVE STE 401
CHICAGO IL
60657-3181
US

IV. Provider business mailing address

4809 N WOLCOTT AVENUE UNIT #1 A
CHICAGO IL
60640-4041
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-1775
  • Fax:
Mailing address:
  • Phone: 778-474-0227
  • Fax: 773-293-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149001595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: