Provider Demographics
NPI:1164581153
Name:CHENCINSKI, JON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:CHENCINSKI
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 1:5209 N CLARK ST
Mailing Address - Street 2:2M
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2101
Mailing Address - Country:US
Mailing Address - Phone:773-858-8061
Mailing Address - Fax:773-561-5764
Practice Address - Street 1:5209 N CLARK ST
Practice Address - Street 2:2M
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2101
Practice Address - Country:US
Practice Address - Phone:773-858-8061
Practice Address - Fax:773-561-5764
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical