Provider Demographics
NPI:1073734604
Name:LUSTIG, VALERIE (MS LCPC)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:LUSTIG
Suffix:
Gender:F
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 1:3166 N. LINCOLN AVE. SUITE 322
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-206-7867
Mailing Address - Fax:847-332-2449
Practice Address - Street 1:3166 N. LINCOLN AVE.
Practice Address - Street 2:SUITE 322
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-206-7867
Practice Address - Fax:847-332-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634433OtherBLUR CROSS BLUE SHIELD