Provider Demographics
NPI:1043548167
Name:TIVERS, ERIC S (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:TIVERS
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 SINGING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8207
Mailing Address - Country:US
Mailing Address - Phone:224-636-3742
Mailing Address - Fax:
Practice Address - Street 1:955 SINGING HILLS DR
Practice Address - Street 2:
Practice Address - City:VOLO
Practice Address - State:IL
Practice Address - Zip Code:60073-8207
Practice Address - Country:US
Practice Address - Phone:224-636-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490139591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical