Provider Demographics
NPI:1588002729
Name:LARUCCI, NICOLE M (LCPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:LARUCCI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 S. EMERALD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051
Mailing Address - Country:US
Mailing Address - Phone:630-338-3696
Mailing Address - Fax:224-678-9652
Practice Address - Street 1:1301 PYOTT ROAD SUITE 201E
Practice Address - Street 2:SUITE #202
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156
Practice Address - Country:US
Practice Address - Phone:224-703-6504
Practice Address - Fax:224-678-9652
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180008684OtherLICENSE NBR