Healthcare Provider Details

I. General information

NPI: 1669783486
Provider Name (Legal Business Name): CHRISTIAN ANTONIO ZAPATA MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 W ROOSEVELT RD
CHICAGO IL
60624-4343
US

IV. Provider business mailing address

3410 W ROOSEVELT RD
CHICAGO IL
60624-4343
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-2929
  • Fax: 773-826-2964
Mailing address:
  • Phone: 773-826-2929
  • Fax: 773-826-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: