MEDICARE: SIVI CERUTI KIZINGA LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093557829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVI CERUTI KIZINGA LCSWA

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 DAVIS PARK RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-0116
Country	:	US
Telephone Number	:	704-866-6618
Fax Number	:	704-866-6320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	12/17/2025

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