Doctor Name: | MR. JOHN LEE CECILIA |
NPI Number: | 1104126010 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 149-015097 |
Business Practice Address: | 1113 S Milwaukee Ave Suite 104 Libertyville, IL - 600483758 |
Business Phone Number: | 8473675991 |
Business Fax Number: | 8473675997 |
Mailing Address: | 1113 S Milwaukee Ave, Suite 104 LIBERTYVILLE |
State: | IL |
Postal Code: | 600483758 |
Phone Number: | 8473675991 |
Fax Number: | 8473675997 |
NPI Enumeration Date: | 10/25/2010 |
NPI Last Update Date: | 09/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149-015097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |