Healthcare Provider Details

I. General information

NPI: 1386796027
Provider Name (Legal Business Name): MR. JOSEPH SERIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 224-205-3747
  • Fax:
Mailing address:
  • Phone: 224-205-3747
  • Fax: 847-524-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-004610
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180004610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: