Provider Demographics
NPI:1487637641
Name:FIERRO, MIDDY ESTHER (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MIDDY
Middle Name:ESTHER
Last Name:FIERRO
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 BELAIRE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2401
Mailing Address - Country:US
Mailing Address - Phone:630-428-0057
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST STE 290F
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-428-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030581041C0700X
IL149.0146861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA084618000OtherMAGELLAN
MAP01325OtherBCBS
MA084618000OtherMAGELLAN