Healthcare Provider Details

I. General information

NPI: 1174281950
Provider Name (Legal Business Name): GEOVANNY JAVIER GARCIA LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 FOXPOINTE DR
SYCAMORE IL
60178-3290
US

IV. Provider business mailing address

760 FOXPOINTE DR
SYCAMORE IL
60178-3290
US

V. Phone/Fax

Practice location:
  • Phone: 815-748-8334
  • Fax: 815-748-8921
Mailing address:
  • Phone: 815-748-8334
  • Fax: 815-748-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.1111489
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: