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General NPI Number Information
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NPI Number | 1639441587
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Entity Type | Individual
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Provider Name | JEFFREY WILLIAM ZACHARIAS LCSW, CADC
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Gender | Male
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 2420 W WINNEMAC AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2614
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Country | US
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Telephone | 773-720-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 2576 W ARGYLE ST UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60625-2604
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Country | US
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Telephone | 773-720-0068
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.015042
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License Number State | IL
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