Healthcare Provider Details

I. General information

NPI: 1194815944
Provider Name (Legal Business Name): LORRAINE D D'ASTA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CHICAGO AVE
HINSDALE IL
60521-3356
US

IV. Provider business mailing address

115 S EDGEWOOD AVE
LA GRANGE IL
60525-2149
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-9040
  • Fax: 708-482-0667
Mailing address:
  • Phone: 630-655-9040
  • Fax: 708-482-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71-2763
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1163916
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: