Provider Demographics
NPI:1942886049
Name:FIORE, KYLE M (LSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:FIORE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 N 3650TH RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IL
Mailing Address - Zip Code:60551-9553
Mailing Address - Country:US
Mailing Address - Phone:630-234-9490
Mailing Address - Fax:
Practice Address - Street 1:1761 S NAPERVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-635-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.110071104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker