Provider Demographics
NPI:1184180432
Name:LIBERATORE, MATTHEW (LCPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LIBERATORE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:THOMAS
Other - Last Name:LIBERATORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1800 W GRACE ST APT 421
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6089
Mailing Address - Country:US
Mailing Address - Phone:312-813-4024
Mailing Address - Fax:
Practice Address - Street 1:1800 W GRACE ST APT 421
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6089
Practice Address - Country:US
Practice Address - Phone:312-813-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012021OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR