MEDICARE: THOMAS CICERO LCSW

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	101YM0800X	Mental Health Counselor	149022241	IL

General Provider Information

NPI Number	:	1609492933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS CICERO LCSW

Provider Business Mailing Address
First Line	:	3950 N LAKE SHORE DR APT 1310B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 N LAKE SHORE DR APT 1310B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3491
Country	:	US
Telephone Number	:	312-420-9256
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	02/26/2025

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