Provider Demographics
NPI:1376215319
Name:CJ DZIUBAN, LCSW, LLC
Entity type:Organization
Organization Name:CJ DZIUBAN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DZIUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-529-6874
Mailing Address - Street 1:1801 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1730
Mailing Address - Country:US
Mailing Address - Phone:815-529-6874
Mailing Address - Fax:
Practice Address - Street 1:421 N WATER ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1188
Practice Address - Country:US
Practice Address - Phone:815-529-6874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty