Provider Demographics
NPI:1639604457
Name:NEGOITA, MELISSA VITT (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:VITT
Last Name:NEGOITA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CAROL
Other - Last Name:VITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5250 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4460
Mailing Address - Country:US
Mailing Address - Phone:872-239-5320
Mailing Address - Fax:
Practice Address - Street 1:5250 OLD ORCHARD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4460
Practice Address - Country:US
Practice Address - Phone:872-239-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490137251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical