Healthcare Provider Details

I. General information

NPI: 1477447134
Provider Name (Legal Business Name): ENRIQUE GARCIA PIMENTEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 S KENNETH AVE FL 2
CHICAGO IL
60629-5209
US

IV. Provider business mailing address

6149 S KENNETH AVE FL 2
CHICAGO IL
60629-5209
US

V. Phone/Fax

Practice location:
  • Phone: 773-581-4357
  • Fax: 773-498-7186
Mailing address:
  • Phone: 773-581-4357
  • Fax: 773-498-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: