1164439485 NPI number — BRIAN LEO RZEPCZYNSKI MSW, LCSW

Table of content: BRIAN LEO RZEPCZYNSKI MSW, LCSW (NPI 1164439485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164439485 NPI number — BRIAN LEO RZEPCZYNSKI MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RZEPCZYNSKI
Provider First Name:
BRIAN
Provider Middle Name:
LEO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164439485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4255 WESTBROOK DR
Provider Second Line Business Mailing Address:
STE. 225
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60504-8125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-375-7416
Provider Business Mailing Address Fax Number:
630-499-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4255 WESTBROOK DR
Provider Second Line Business Practice Location Address:
STE. 225
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-8125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-375-7416
Provider Business Practice Location Address Fax Number:
630-499-1082
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149-006219 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 320030101 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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