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General NPI Number Information
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NPI Number | 1730812710
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Entity Type | Individual
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Provider Name | TILLY-ANA CERISER LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 7381 N WINCHESTER AVE APT 2W
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City | CHICAGO
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State | IL
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Zip | 60626-5510
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Country | US
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Telephone | 224-645-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 9631 S CICERO AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-3137
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Country | US
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Telephone | 708-529-0704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150105718
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 150105718
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License Number State | IL
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