Provider Demographics
NPI:1710038559
Name:NIETO, LUCINDA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:A
Last Name:NIETO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 CRAWFORD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1700
Mailing Address - Country:US
Mailing Address - Phone:847-674-8290
Mailing Address - Fax:847-674-6385
Practice Address - Street 1:9150 CRAWFORD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1700
Practice Address - Country:US
Practice Address - Phone:847-674-8290
Practice Address - Fax:847-674-6385
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622647OtherBLUE CROSS
IL571500Medicare ID - Type Unspecified