Provider Demographics
NPI:1295202802
Name:MALFITANO, LYZANNE VICTORIA (LPC)
Entity Type:Individual
Prefix:
First Name:LYZANNE
Middle Name:VICTORIA
Last Name:MALFITANO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3926
Mailing Address - Country:US
Mailing Address - Phone:630-390-8390
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3053
Practice Address - Country:US
Practice Address - Phone:312-762-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health