Provider Demographics
NPI:1912390089
Name:RAIMONDI, GINA (LCSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:RAIMONDI
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 1:306 PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1433
Mailing Address - Country:US
Mailing Address - Phone:815-784-3846
Mailing Address - Fax:
Practice Address - Street 1:2 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4341
Practice Address - Country:US
Practice Address - Phone:847-742-3545
Practice Address - Fax:847-742-3559
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0098131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2447195OtherMEDICARE
IL36-2447195Medicare PIN
IL36-2447195OtherMEDICARE
IL362447195Medicare Oscar/Certification