Provider Demographics
NPI:1639601974
Name:AMODEO, LISA M (LCPC, CRADC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:AMODEO
Suffix:
Gender:F
Credentials:LCPC, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3204
Mailing Address - Country:US
Mailing Address - Phone:888-261-2178
Mailing Address - Fax:847-847-7495
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3204
Practice Address - Country:US
Practice Address - Phone:888-261-2178
Practice Address - Fax:847-847-7495
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32734101YA0400X
IL180010582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)