Healthcare Provider Details

I. General information

NPI: 1548824543
Provider Name (Legal Business Name): KAREN CIPRIANO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JORIE BLVD STE 48
OAK BROOK IL
60523-4498
US

IV. Provider business mailing address

739 S YALE AVE
VILLA PARK IL
60181-2875
US

V. Phone/Fax

Practice location:
  • Phone: 630-272-0106
  • Fax:
Mailing address:
  • Phone: 630-272-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180012197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: