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General NPI Number Information
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NPI Number | 1275978082
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Entity Type | Organization
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Legal Business Name | DR LUCIA LICAVOLI PHD PC
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 24W788 75TH ST
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City | NAPERVILLE
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State | IL
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Zip | 60565
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Country | US
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Telephone | 630-330-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 3S101 ROCKWELL ST UNIT 886
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City | WARRENVILLE
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State | IL
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Zip | 60555-2992
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Country | US
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Telephone | 630-330-4191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCIA LICAVOLI
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Credential | PHD
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Telephone | 630-330-4191
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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 | 071.004881
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License Number State | IL
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