Provider Demographics
NPI:1437555695
Name:COFFARO, RICK (LPC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:COFFARO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4740
Mailing Address - Country:US
Mailing Address - Phone:847-514-2104
Mailing Address - Fax:
Practice Address - Street 1:61 S OLD RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3127
Practice Address - Country:US
Practice Address - Phone:847-438-4222
Practice Address - Fax:847-438-0844
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor