MEDICARE: MAYA JIMENEZ LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356295042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYA JIMENEZ LCSW PLLC

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR STE 1102316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	773-270-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 N RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2619
Country	:	US
Telephone Number	:	773-270-3368
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAYA JIMENEZ-WAINGORT
Credential	:	LCSW
Telephone Number	:	917-514-0179

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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