Healthcare Provider Details

I. General information

NPI: 1245703115
Provider Name (Legal Business Name): PAIGE CEDERNA LCSW, MPH, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 2023
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

5710 N BROADWAY ST
CHICAGO IL
60660-4302
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3434
  • Fax:
Mailing address:
  • Phone: 773-728-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: