Healthcare Provider Details

I. General information

NPI: 1316680945
Provider Name (Legal Business Name): RICHARD CUCINOTTA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W ADAMS ST STE 514
CHICAGO IL
60606-5108
US

IV. Provider business mailing address

300 W ADAMS ST STE 514
CHICAGO IL
60606-5108
US

V. Phone/Fax

Practice location:
  • Phone: 312-578-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: