=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376229799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESIREE R AVITIA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2023
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37W755 IL ROUTE 38 STE A
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175-7557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-232-6840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37W755 IL ROUTE 38 STE A
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60175-7557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-523-5318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.024393
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------