Provider Demographics
NPI:1043472624
Name:SCIANNA, CARL ROY (MS, LCPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:ROY
Last Name:SCIANNA
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4143
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4143
Mailing Address - Country:US
Mailing Address - Phone:630-290-7762
Mailing Address - Fax:
Practice Address - Street 1:1263 S HIGHLAND AVE STE 2D
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4527
Practice Address - Country:US
Practice Address - Phone:630-408-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional