Healthcare Provider Details

I. General information

NPI: 1386048965
Provider Name (Legal Business Name): JERRY CIFFONE MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY CIFFONE MSW, LCSW

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S 9TH ST
SAINT CHARLES IL
60174-2612
US

IV. Provider business mailing address

406 S 9TH ST
SAINT CHARLES IL
60174-2612
US

V. Phone/Fax

Practice location:
  • Phone: 630-940-2960
  • Fax:
Mailing address:
  • Phone: 630-940-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.000360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: