Healthcare Provider Details

I. General information

NPI: 1427479583
Provider Name (Legal Business Name): KIMBERLY CIMINO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 LAKE ST SUITE 201
OAK PARK IL
60301-1085
US

IV. Provider business mailing address

1101 LAKE ST SUITE 201
OAK PARK IL
60301-1085
US

V. Phone/Fax

Practice location:
  • Phone: 708-870-6064
  • Fax:
Mailing address:
  • Phone: 708-870-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000886
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: