Healthcare Provider Details

I. General information

NPI: 1174140255
Provider Name (Legal Business Name): SOPHIA MAE CIPRIANO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD FL 3
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

1755 N SAWYER AVE UNIT 2
CHICAGO IL
60647-4916
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2317
  • Fax:
Mailing address:
  • Phone: 414-793-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: