Provider Demographics
NPI:1285812925
Name:ESQUIVEL, JAIME (LCSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 W FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2103
Mailing Address - Country:US
Mailing Address - Phone:773-293-2910
Mailing Address - Fax:
Practice Address - Street 1:2525 W PETERSON AVE
Practice Address - Street 2:C4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4108
Practice Address - Country:US
Practice Address - Phone:773-506-2525
Practice Address - Fax:773-765-0622
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL149.0146601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical