Provider Demographics
NPI:1538657168
Name:LAMACCHIA, NOELLE (MHP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:LAMACCHIA
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:IL
Mailing Address - Zip Code:62898-1119
Mailing Address - Country:US
Mailing Address - Phone:618-231-3257
Mailing Address - Fax:
Practice Address - Street 1:4110 N WATER TOWER PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6295
Practice Address - Country:US
Practice Address - Phone:618-242-8266
Practice Address - Fax:618-242-1150
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health