MEDICARE: ROSA CISNEROS LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.108637	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150108637	OTHER	IL	LSW

General Provider Information

NPI Number	:	1467319400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA CISNEROS LSW

Provider Business Mailing Address
First Line	:	1940 S WESTERN AVE STE 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2503
Country	:	US
Telephone Number	:	773-584-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4058 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-4639
Country	:	US
Telephone Number	:	773-584-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ ROSA CISNEROS LSW” Practice Location

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