Provider Demographics
NPI:1124902895
Name:NIQUIE DWORKIN, INC
Entity type:Organization
Organization Name:NIQUIE DWORKIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DWORKIN-CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-405-7169
Mailing Address - Street 1:3322 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0195
Mailing Address - Country:US
Mailing Address - Phone:773-472-8587
Mailing Address - Fax:
Practice Address - Street 1:3322 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0195
Practice Address - Country:US
Practice Address - Phone:773-472-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIQUIE DWORKIN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health