Healthcare Provider Details

I. General information

NPI: 1023833548
Provider Name (Legal Business Name): CAITLIN REIFFMAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DAVIS ST
EVANSTON IL
60201-4619
US

IV. Provider business mailing address

1200 W PRATT BLVD APT 412
CHICAGO IL
60626-4380
US

V. Phone/Fax

Practice location:
  • Phone: 312-815-9660
  • Fax:
Mailing address:
  • Phone: 312-841-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: