Healthcare Provider Details

I. General information

NPI: 1518236660
Provider Name (Legal Business Name): MS. CATHERINE TIBERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 LARKIN AVE
ELGIN IL
60123-6042
US

IV. Provider business mailing address

1212 LARKIN AVE
ELGIN IL
60123-6042
US

V. Phone/Fax

Practice location:
  • Phone: 847-608-2682
  • Fax: 847-608-2689
Mailing address:
  • Phone: 847-608-2682
  • Fax: 847-608-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: