Healthcare Provider Details

I. General information

NPI: 1669317491
Provider Name (Legal Business Name): NICOLE FUSCALDO PHD, CRC, CVE, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0833
US

IV. Provider business mailing address

1333 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0833
US

V. Phone/Fax

Practice location:
  • Phone: 815-762-7759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number116441
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014927
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: