Provider Demographics
NPI:1083240410
Name:GERMINO, MARIBETH GOMEZ (LCPC)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:GOMEZ
Last Name:GERMINO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:CUSTODIO
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6062
Mailing Address - Country:US
Mailing Address - Phone:224-764-1334
Mailing Address - Fax:
Practice Address - Street 1:176 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6062
Practice Address - Country:US
Practice Address - Phone:224-764-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014940101YP2500X
IL180014002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional