Provider Demographics
NPI:1437674892
Name:LABRIOLA, WHITNEY (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:LABRIOLA
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 MISTY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5043
Mailing Address - Country:US
Mailing Address - Phone:630-456-1070
Mailing Address - Fax:
Practice Address - Street 1:301 EATON AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1701
Practice Address - Country:US
Practice Address - Phone:815-886-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool