Basic Information
Provider Information
NPI: 1003003658
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUTINELLO
FirstName: REEM
MiddleName: KURDI
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15419 E 127TH ST
Address2:  
City: LEMONT
State: IL
PostalCode: 604396494
CountryCode: US
TelephoneNumber: 6307777113
FaxNumber:  
Practice Location
Address1: 15419 E 127TH ST
Address2:  
City: LEMONT
State: IL
PostalCode: 604396494
CountryCode: US
TelephoneNumber: 6307777113
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2007
LastUpdateDate: 08/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149.012665ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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