Healthcare Provider Details

I. General information

NPI: 1629436035
Provider Name (Legal Business Name): FELICIA-MARIE NICOSIA MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE
CHICAGO IL
60625-7014
US

IV. Provider business mailing address

1291 PADRE ISLAND LN
PINGREE GROVE IL
60140-2083
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-5809
  • Fax:
Mailing address:
  • Phone: 847-354-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178003565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: