Provider Demographics
NPI:1871102509
Name:ALCANTARA, GABRIEL VINCENTE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:VINCENTE
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 N MILWAUKEE AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6635
Mailing Address - Country:US
Mailing Address - Phone:773-459-8702
Mailing Address - Fax:
Practice Address - Street 1:1448 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9225
Practice Address - Country:US
Practice Address - Phone:312-476-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0218561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical