Healthcare Provider Details

I. General information

NPI: 1770335531
Provider Name (Legal Business Name): GINA CIULLA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N ARLINGTON HEIGHTS RD STE 203
ARLINGTON HEIGHTS IL
60004-3980
US

IV. Provider business mailing address

1616 N ARLINGTON HEIGHTS RD STE 203
ARLINGTON HEIGHTS IL
60004-3980
US

V. Phone/Fax

Practice location:
  • Phone: 847-595-0262
  • Fax:
Mailing address:
  • Phone: 847-595-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: