Provider Demographics
NPI:1104867639
Name:FERRARESI, LAURETTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURETTE
Middle Name:M
Last Name:FERRARESI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 CHARAL LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5102
Mailing Address - Country:US
Mailing Address - Phone:312-307-8367
Mailing Address - Fax:866-626-5479
Practice Address - Street 1:100 VILLAGE GRN STE 220
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3095
Practice Address - Country:US
Practice Address - Phone:312-307-8367
Practice Address - Fax:866-626-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP17153Medicare UPIN
IL998690Medicare PIN