Healthcare Provider Details

I. General information

NPI: 1720901374
Provider Name (Legal Business Name): STUDIO TWENTY THREE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 VOSE DR APT 403
GURNEE IL
60031-3192
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 110-1449
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 872-265-1473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LOLA MARIE CICCONE DAMATO
Title or Position: OWNER AND LICENSED PSYCHOTHERAPIST
Credential: LCPC, NCC
Phone: 872-265-1473