Provider Demographics
NPI:1194815944
Name:D'ASTA, LORRAINE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:D
Last Name:D'ASTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2149
Mailing Address - Country:US
Mailing Address - Phone:630-655-9040
Mailing Address - Fax:708-482-0667
Practice Address - Street 1:111 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3356
Practice Address - Country:US
Practice Address - Phone:630-655-9040
Practice Address - Fax:708-482-0667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-2763103TC0700X
IL1163916103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227-2056OtherBCBS PROVIDER ID