Provider Demographics
NPI:1366018699
Name:DEL CARMEN, MELISSA BRENDA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BRENDA
Last Name:DEL CARMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HIGHBURY DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4562
Mailing Address - Country:US
Mailing Address - Phone:630-229-4254
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4192
Practice Address - Country:US
Practice Address - Phone:312-772-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional