Doctor Name: | MARCO FORMIGONI |
NPI Number: | 1295164093 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 149014838 |
Business Practice Address: | 246 Elgin Ave Forest Park, IL - 601301306 |
Business Phone Number: | 3129456723 |
Business Fax Number: | |
Mailing Address: | 246 Elgin Ave, FOREST PARK |
State: | IL |
Postal Code: | 601301306 |
Phone Number: | 3129456723 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2013 |
NPI Last Update Date: | 11/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149014838 |
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 |