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NPI Code Detail

MEDICARE: JENNIFER DICOSTANZO

MEDICARE: JENNIFER DICOSTANZO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor30755IL
21041C0700XClinical Social Worker149.018138IL

General Provider Information

NPI Number : 1487072070
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DICOSTANZO
Provider Business Mailing Address
First Line : 1080 SERENDIPITY DR
Second Line :
City : AURORA
State : IL
Zip : 60504-4737
Country : US
Telephone Number : 630-973-8583
Fax Number :
Provider Business Practice Location Address
First Line : 1755 PARK ST STE 200
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-8404
Country : US
Telephone Number : 331-305-4464
Fax Number : 630-381-8556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 01/18/2024

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Directions to “ JENNIFER DICOSTANZO ” Practice Location

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