Healthcare Provider Details

I. General information

NPI: 1154991248
Provider Name (Legal Business Name): EWELINA PITON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR STE 306
NAPERVILLE IL
60563-9792
US

IV. Provider business mailing address

636 RAYMOND DR STE 306
NAPERVILLE IL
60563-9792
US

V. Phone/Fax

Practice location:
  • Phone: 331-732-4500
  • Fax: 331-732-4505
Mailing address:
  • Phone: 331-732-4500
  • Fax: 331-732-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149018530
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: