Provider Demographics
NPI:1093986069
Name:PERSINO, LOUIS
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:PERSINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E HURON ST
Mailing Address - Street 2:UNIT #1106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2766
Mailing Address - Country:US
Mailing Address - Phone:847-997-7157
Mailing Address - Fax:312-873-4492
Practice Address - Street 1:30 E HURON ST
Practice Address - Street 2:UNIT #1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2766
Practice Address - Country:US
Practice Address - Phone:847-997-7157
Practice Address - Fax:312-873-4492
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional