Healthcare Provider Details

I. General information

NPI: 1336716422
Provider Name (Legal Business Name): VANESSA JAYNE DEMITO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W HIGGINS RD STE 570
HOFFMAN ESTATES IL
60169-7210
US

IV. Provider business mailing address

288 NANTUCKET HBR
SCHAUMBURG IL
60193-4253
US

V. Phone/Fax

Practice location:
  • Phone: 224-698-9792
  • Fax:
Mailing address:
  • Phone: 630-926-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: