Provider Demographics
NPI:1073662623
Name:NARDI, LISA MARIA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIA
Last Name:NARDI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:MCLEAREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:15020 S RAVINIA AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3166
Mailing Address - Country:US
Mailing Address - Phone:708-873-9059
Mailing Address - Fax:708-428-4504
Practice Address - Street 1:15020 S RAVINIA AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3166
Practice Address - Country:US
Practice Address - Phone:708-873-9059
Practice Address - Fax:708-428-4504
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional