Provider Demographics
NPI:1184852121
Name:NAZARIO, CHRISTINE M (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 W MONTROSE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1559
Mailing Address - Country:US
Mailing Address - Phone:312-513-2336
Mailing Address - Fax:312-284-4528
Practice Address - Street 1:2656 W MONTROSE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1559
Practice Address - Country:US
Practice Address - Phone:312-513-2336
Practice Address - Fax:312-284-4528
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006550101YP2500X
IL178003657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional