Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | IL | |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1194498899 |
---|---|
Provider Name | Calvin Alessandro Fiore |
First Address | Chicago, IL 60601-7713 |
Second Address | Barrington, IL 60010-4332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |