Provider Demographics
NPI:1508311036
Name:SERRANO, JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2713
Mailing Address - Country:US
Mailing Address - Phone:847-256-7334
Mailing Address - Fax:847-256-7370
Practice Address - Street 1:2049 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2713
Practice Address - Country:US
Practice Address - Phone:847-256-7334
Practice Address - Fax:847-256-7370
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor