Provider Demographics
NPI:1447302427
Name:KHESHGI, ZAREENA (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:ZAREENA
Middle Name:
Last Name:KHESHGI
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:DR
Other - First Name:ZAREENA
Other - Middle Name:
Other - Last Name:KHESHGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LCSW
Mailing Address - Street 1:4809 N WOLCOTT AVENUE
Mailing Address - Street 2:UNIT #1 A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4041
Mailing Address - Country:US
Mailing Address - Phone:778-474-0227
Mailing Address - Fax:773-293-4446
Practice Address - Street 1:3166 N LINCOLN AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3181
Practice Address - Country:US
Practice Address - Phone:888-870-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490015951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632262OtherBLUE CROSS BLUE SHIELD
077258000OtherMAGELLAN HEALTH