Provider Demographics
NPI:1508384611
Name:SHASTRI, RUCHA B (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:RUCHA
Middle Name:B
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N NAPER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8830
Mailing Address - Country:US
Mailing Address - Phone:630-791-5746
Mailing Address - Fax:630-283-8841
Practice Address - Street 1:1804 N NAPER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8830
Practice Address - Country:US
Practice Address - Phone:630-791-5746
Practice Address - Fax:630-283-8841
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional