Provider Demographics
NPI:1154488294
Name:SISCO, MONICA (LCSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SISCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4106
Mailing Address - Country:US
Mailing Address - Phone:630-518-2717
Mailing Address - Fax:630-801-0634
Practice Address - Street 1:412 N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4106
Practice Address - Country:US
Practice Address - Phone:630-518-2717
Practice Address - Fax:630-801-0634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL78623219OtherUNITED BEHAVIORAL HEALTH
IL202525OtherVALUE OPTIONS
IL4504901OtherBLUE CROSS BLUE SHIELD
IL5231295OtherAETNA
IL992160Medicare ID - Type Unspecified