Provider Demographics
NPI:1558913137
Name:PONTILLO, TREVOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:PONTILLO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3220
Mailing Address - Country:US
Mailing Address - Phone:815-344-5061
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 426
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7671
Practice Address - Country:US
Practice Address - Phone:630-323-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0213171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical