Provider Demographics
NPI:1093579302
Name:KIMONDO, FLORENCE W (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:W
Last Name:KIMONDO
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 DODGE AVE.
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:224-777-0570
Mailing Address - Fax:
Practice Address - Street 1:2012 BRUMMEL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3606
Practice Address - Country:US
Practice Address - Phone:224-777-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0262151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical