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General NPI Number Information
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NPI Number | 1316894561
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Entity Type | Individual
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Provider Name | KIMBERLY DEMETRIO LPC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 450 E 22ND ST
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City | LOMBARD
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State | IL
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Zip | 60148-6113
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Country | US
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Telephone | 630-474-3900
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Fax | 630-474-3903
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Provider Business Mailing Address
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Address Line | 220 S WASHINGTON ST
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City | LOCKPORT
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State | IL
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Zip | 60441-2961
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Country | US
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Telephone | 815-999-7447
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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 | 178.032702
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License Number State | IL
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