Provider Demographics
NPI:1912390089
Name:RAIMONDI, GINA LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LOUISE
Last Name:RAIMONDI
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 MIDLANDS CT STE 107
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3199
Mailing Address - Country:US
Mailing Address - Phone:847-404-7918
Mailing Address - Fax:
Practice Address - Street 1:2128 MIDLANDS CT STE 107
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3199
Practice Address - Country:US
Practice Address - Phone:847-404-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0098131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2447195OtherMEDICARE
IL36-2447195Medicare PIN
IL36-2447195OtherMEDICARE
IL362447195Medicare Oscar/Certification