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General NPI Number Information
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NPI Number | 1912374968
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Entity Type | Individual
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Provider Name | LATIFAT CABIROU PHD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 2622 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-6172
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Country | US
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Telephone | 312-953-4924
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Fax |
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Provider Business Mailing Address
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Address Line | 883 COMMONWEALTH AVE SE
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City | ATLANTA
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State | GA
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Zip | 30312-3663
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Country | US
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Telephone | 773-679-9555
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071010777
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178011105
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License Number State | IL
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