Healthcare Provider Details

I. General information

NPI: 1790338622
Provider Name (Legal Business Name): MARIANA TSIGISTRAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 09/29/2026
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S RIVER ST
AURORA IL
60506-5185
US

IV. Provider business mailing address

434 MCDANIELS CIR UNIT 301
CLARENDON HILLS IL
60514-2157
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax: 630-844-3084
Mailing address:
  • Phone: 773-896-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150112860
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: