Healthcare Provider Details

I. General information

NPI: 1942921408
Provider Name (Legal Business Name): DANIEL STRIBLING-VERGARA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 SHERMAN AVE STE 207
EVANSTON IL
60201-3753
US

IV. Provider business mailing address

2045 W GRAND AVE STE B222523
CHICAGO IL
60612-1576
US

V. Phone/Fax

Practice location:
  • Phone: 210-960-6579
  • Fax:
Mailing address:
  • Phone: 210-960-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number149021502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: