Provider Demographics
NPI:1245034743
Name:INFANZON, RICARDO JOSE
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:JOSE
Last Name:INFANZON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5120
Mailing Address - Country:US
Mailing Address - Phone:787-507-1880
Mailing Address - Fax:
Practice Address - Street 1:311 N 2ND ST UNIT 203
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1850
Practice Address - Country:US
Practice Address - Phone:630-377-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501145871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical