Provider Demographics
NPI:1164717542
Name:LAROCCO, NICOLE (PSYD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:LAROCCO
Suffix:
Gender:F
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHANTICLEER LN
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-5022
Mailing Address - Country:US
Mailing Address - Phone:630-570-0525
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 418
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7665
Practice Address - Country:US
Practice Address - Phone:630-570-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL088$$$$$$$$$001Medicaid