Provider Demographics
NPI:1780275529
Name:MALTESE GIO, TINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:MALTESE GIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:GIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:941 S KIRK AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5128
Mailing Address - Country:US
Mailing Address - Phone:773-427-8783
Mailing Address - Fax:
Practice Address - Street 1:941 S KIRK AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5128
Practice Address - Country:US
Practice Address - Phone:773-427-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14900903341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical