Basic Information
| Provider Information | |||||||||
| NPI: | 1992187983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCOBAR | ||||||||
| FirstName: | GIOVANNI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11007 RALEIGH ST | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601544933 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9845 W ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601542758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086812325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NONE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.