Provider Demographics
NPI:1437802915
Name:RYADDIGAN, DOMINIC GIAFAGLEONE (LCSW)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:GIAFAGLEONE
Last Name:RYADDIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DOMINIC
Other - Middle Name:MC
Other - Last Name:GIAFAGLEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3225 HEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6248
Mailing Address - Country:US
Mailing Address - Phone:217-726-7300
Mailing Address - Fax:
Practice Address - Street 1:3225 HEDLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6248
Practice Address - Country:US
Practice Address - Phone:217-726-7300
Practice Address - Fax:217-726-5989
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0231391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149023139OtherLCSW