Basic Information
| Provider Information | |||||||||
| NPI: | 1912390089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAIMONDI | ||||||||
| FirstName: | GINA | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 PRESERVE DR | ||||||||
| Address2: | |||||||||
| City: | GENOA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601351433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157843846 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601204341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477423545 | ||||||||
| FaxNumber: | 8477423559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2015 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.009813 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 36-2447195 | 01 | IL | MEDICARE | OTHER |