Provider Demographics
NPI:1972734655
Name:LAMAGNA, GLICERIO DELEON JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLICERIO
Middle Name:DELEON
Last Name:LAMAGNA
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:MEL
Other - Middle Name:
Other - Last Name:LAMAGNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1300 W BELMONT AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-510-1155
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-510-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490113751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical