Provider Demographics
NPI:1457446668
Name:KOSNICK, CYNTHIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:KOSNICK
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 1:253 E DELAWARE PL APT 8A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5738
Mailing Address - Country:US
Mailing Address - Phone:708-334-3754
Mailing Address - Fax:
Practice Address - Street 1:20635 ABBEY WOODS CT N STE 309
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3217
Practice Address - Country:US
Practice Address - Phone:708-480-2448
Practice Address - Fax:815-534-5369
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150-009931104100000X
IL1490125571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker