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General NPI Number Information
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NPI Number | 1124789284
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Entity Type | Individual
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Provider Name | IRINA M GIMENA LCSW, CADC, CCM
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Gender | Female
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Dates
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Enumeration Date | 12/31/2021
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 212 S MARION ST STE 9
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City | OAK PARK
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State | IL
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Zip | 60302-3159
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Country | US
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Telephone | 847-334-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 MARGUERITE ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1934
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Country | US
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Telephone | 184-733-4301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 29631
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 4242224
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149016241
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License Number State | IL
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