Provider Demographics
NPI:1790261907
Name:JONES, CAMESHA LYNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMESHA
Middle Name:LYNETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 S EVERETT AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1930
Mailing Address - Country:US
Mailing Address - Phone:240-533-2876
Mailing Address - Fax:
Practice Address - Street 1:1750 E 71ST ST STE L
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1913
Practice Address - Country:US
Practice Address - Phone:312-880-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103086104100000X
IL149.0219521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149021952OtherLICENSE CLINICAL SOCIAL WORKER