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NPI Code Detail

MEDICARE: MAURICIO J CIFUENTES LCSW

MEDICARE: MAURICIO J CIFUENTES LCSW
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
11041C0700XClinical Social Worker149011442KS

General Provider Information

NPI Number : 1609029404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURICIO J CIFUENTES LCSW
Provider Business Mailing Address
First Line : 6007 N SHERIDAN RD APT 36D
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3012
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3047 N LINCOLN AVE UNIT 400
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4274
Country : US
Telephone Number : 773-849-4709
Fax Number : 773-883-1535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2008
Last Update Date : 10/24/2008

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