Healthcare Provider Details

I. General information

NPI: 1942702717
Provider Name (Legal Business Name): ALEXANDER SERRANO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST STE 20
OAK PARK IL
60302-3159
US

IV. Provider business mailing address

212 S MARION ST STE 20
OAK PARK IL
60302-3159
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax: 773-409-3531
Mailing address:
  • Phone: 312-415-5507
  • Fax: 773-409-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: