Provider Demographics
NPI:1225672025
Name:GONZALEZ, XOCHITL DALILA (LCSW)
Entity Type:Individual
Prefix:
First Name:XOCHITL
Middle Name:DALILA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:XOCHITL
Other - Middle Name:D
Other - Last Name:JARAMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6649 S KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5125
Mailing Address - Country:US
Mailing Address - Phone:312-736-2011
Mailing Address - Fax:
Practice Address - Street 1:6649 S KARLOV AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5125
Practice Address - Country:US
Practice Address - Phone:708-745-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0203061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical