=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790581379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IMANI DALCOE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1242 W NORTHWEST HWY
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-1897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-261-2178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9076 FRAZIER ST
-----------------------------------------------------
City | DEL RIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78840-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-481-6783
-----------------------------------------------------
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 | 150115363
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------