MEDICARE: NAOMI JIMENEZ 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
1	1041C0700X	Clinical Social Worker	149.019329	IL

General Provider Information

NPI Number	:	1811482888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI JIMENEZ LCSW

Provider Business Mailing Address
First Line	:	2255 W 24TH ST # 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3933
Country	:	US
Telephone Number	:	773-682-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 W 24TH ST # 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3933
Country	:	US
Telephone Number	:	773-682-0024
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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