Provider Demographics
NPI:1467741876
Name:CALATO, STEPHANIE R (LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:CALATO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3504 WIND POINT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3721
Mailing Address - Country:US
Mailing Address - Phone:815-218-7964
Mailing Address - Fax:
Practice Address - Street 1:4615 E STATE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2100
Practice Address - Country:US
Practice Address - Phone:815-218-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional