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General NPI Number Information
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NPI Number | 1104867639
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Entity Type | Individual
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Provider Name | LAURETTE M FERRARESI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 100 VILLAGE GRN STE 220
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3095
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Country | US
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Telephone | 312-307-8367
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Fax | 866-626-4579
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Provider Business Mailing Address
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Address Line | 284 CHARAL LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5102
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Country | US
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Telephone | 312-307-8367
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Fax | 866-626-5479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-005957
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License Number State | IL
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