Healthcare Provider Details

I. General information

NPI: 1205411527
Provider Name (Legal Business Name): TAMARA GASIOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE STE 205
NAPERVILLE IL
60563
US

IV. Provider business mailing address

1524 CHICKASAW DR
NAPERVILLE IL
60563-1306
US

V. Phone/Fax

Practice location:
  • Phone: 630-779-0751
  • Fax:
Mailing address:
  • Phone: 630-346-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: