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NPI Code Detail

MEDICARE: MAYA HAYDEE JIMENEZ WAINGORT LCSW

MEDICARE: MAYA HAYDEE JIMENEZ WAINGORT LCSW
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
11041C0700XClinical Social Worker149.026246IL

General Provider Information

NPI Number : 1477384436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYA HAYDEE JIMENEZ WAINGORT LCSW
Provider Business Mailing Address
First Line : 4141 N KEDZIE AVE STE 2
Second Line :
City : CHICAGO
State : IL
Zip : 60618-2479
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4141 N KEDZIE AVE STE 2
Second Line :
City : CHICAGO
State : IL
Zip : 60618-2479
Country : US
Telephone Number : 773-754-0577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2024
Last Update Date : 08/21/2024

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