Healthcare Provider Details

I. General information

NPI: 1689028748
Provider Name (Legal Business Name): MICHELE COTSIRILOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 02/14/2017
Reactivation Date: 07/29/2026

III. Provider practice location address

1579 S PAUL LE COMTE CT
PALATINE IL
60067-1221
US

IV. Provider business mailing address

1579 S PAUL LE COMTE CT
PALATINE IL
60067-1221
US

V. Phone/Fax

Practice location:
  • Phone: 916-969-3133
  • Fax:
Mailing address:
  • Phone: 916-969-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: