Healthcare Provider Details

I. General information

NPI: 1720138308
Provider Name (Legal Business Name): JEFFREY J. CIOLINO M.A., L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 N KENMORE AVE
CHICAGO IL
60640-5015
US

IV. Provider business mailing address

701 W BITTERSWEET PL #3
CHICAGO IL
60613-2309
US

V. Phone/Fax

Practice location:
  • Phone: 773-905-9805
  • Fax:
Mailing address:
  • Phone: 773-905-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: