Healthcare Provider Details

I. General information

NPI: 1811310667
Provider Name (Legal Business Name): MARIANNE DI VITTORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WASHINGTON CT
WESTMONT IL
60559-1356
US

IV. Provider business mailing address

143 WASHINGTON CT
WESTMONT IL
60559-1356
US

V. Phone/Fax

Practice location:
  • Phone: 630-202-3632
  • Fax:
Mailing address:
  • Phone: 630-202-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number31568
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: