Provider Demographics
NPI:1871271817
Name:SOLIS, VICENTE (LMSW)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:SOLIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 S MANISTEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5328
Mailing Address - Country:US
Mailing Address - Phone:773-474-0329
Mailing Address - Fax:
Practice Address - Street 1:9825 S MANISTEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5328
Practice Address - Country:US
Practice Address - Phone:773-474-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150109403104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker