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General NPI Number Information
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NPI Number | 1154908168
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Entity Type | Individual
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Provider Name | CORAL SERRANO BENNITT MS, LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 3111 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3818
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Country | US
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Telephone | 872-588-1071
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Fax |
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Provider Business Mailing Address
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Address Line | 1071 W 15TH ST UNIT 312
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City | CHICAGO
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State | IL
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Zip | 60608-2581
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Country | US
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Telephone | 203-641-9947
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.013476
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License Number State | IL
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