Provider Demographics
NPI:1114698412
Name:CORRADINO, CODY (LPC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CORRADINO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CONTINENTAL AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3510
Mailing Address - Country:US
Mailing Address - Phone:708-769-3422
Mailing Address - Fax:
Practice Address - Street 1:304 W MONDAMIN ST STE 104
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-4618
Practice Address - Country:US
Practice Address - Phone:708-465-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional