Provider Demographics
NPI:1629338926
Name:NIKIFOROS, GINNY GRIFFIN (LCSW, BCBA)
Entity type:Individual
Prefix:MRS
First Name:GINNY
Middle Name:GRIFFIN
Last Name:NIKIFOROS
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 N ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7804
Mailing Address - Country:US
Mailing Address - Phone:773-726-4832
Mailing Address - Fax:
Practice Address - Street 1:2923 N MILWAUKEE AVE UNIT 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7886
Practice Address - Country:US
Practice Address - Phone:773-726-4832
Practice Address - Fax:773-409-5458
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-14-17879103K00000X
IL1490152681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst