Provider Demographics
NPI:1093268229
Name:SERRANO, GRICEL (LCPC)
Entity Type:Individual
Prefix:
First Name:GRICEL
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST VIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6201 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-5742
Practice Address - Country:US
Practice Address - Phone:708-788-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health