Healthcare Provider Details

I. General information

NPI: 1083998538
Provider Name (Legal Business Name): DEANNA ELIZABETH DAMIANO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 N BROADWAY ST
CHICAGO IL
60660-4302
US

IV. Provider business mailing address

5710 N BROADWAY ST
CHICAGO IL
60660-4302
US

V. Phone/Fax

Practice location:
  • Phone: 872-235-0498
  • Fax:
Mailing address:
  • Phone: 773-728-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: