Basic Information
Provider Information
NPI: 1063642429
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILIANTI
FirstName: CARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 145 S YORK ST UNIT 208
Address2:  
City: ELMHURST
State: IL
PostalCode: 601263468
CountryCode: US
TelephoneNumber: 6308465994
FaxNumber:  
Practice Location
Address1: 6918 WINDSOR AVE
Address2:  
City: BERWYN
State: IL
PostalCode: 604023334
CountryCode: US
TelephoneNumber: 7087455277
FaxNumber: 7087954834
Other Information
ProviderEnumerationDate: 07/20/2009
LastUpdateDate: 11/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149013541ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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