Provider Demographics
NPI:1114315413
Name:NUTINI, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NUTINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 KIMBALL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2476
Mailing Address - Country:US
Mailing Address - Phone:847-983-4242
Mailing Address - Fax:
Practice Address - Street 1:8551 KIMBALL AVE APT 1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2476
Practice Address - Country:US
Practice Address - Phone:847-983-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0028861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical