Healthcare Provider Details

I. General information

NPI: 1508084252
Provider Name (Legal Business Name): SAMANTHA ANNE SCALABRINO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 COMMERCIAL AVE
NORTHBROOK IL
60062-1821
US

IV. Provider business mailing address

1111 WINDBROOKE DR APT 101
BUFFALO GROVE IL
60089-2335
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-5111
  • Fax:
Mailing address:
  • Phone: 847-924-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178004273
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: