Provider Demographics
NPI:1558720714
Name:D'INNOCENZO, LISA MARY (ATR, LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:D'INNOCENZO
Suffix:
Gender:F
Credentials:ATR, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 BAY SCOTT CIR STE 109
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1130
Mailing Address - Country:US
Mailing Address - Phone:331-529-0145
Mailing Address - Fax:
Practice Address - Street 1:1819 BAY SCOTT CIR STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1130
Practice Address - Country:US
Practice Address - Phone:331-529-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional