MEDICARE: XIOMARA VERENICE CERVANTES-GOMEZ

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	150.129112	IL

General Provider Information

NPI Number	:	1770467235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIOMARA VERENICE CERVANTES-GOMEZ

Provider Business Mailing Address
First Line	:	5136 S BLACKSTONE AVE APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4132
Country	:	US
Telephone Number	:	773-420-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	773-420-6137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	03/23/2026

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