Provider Demographics
NPI:1730305996
Name:SALVADORE, LISA M (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:SALVADORE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 LINCOLNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1666
Mailing Address - Country:US
Mailing Address - Phone:630-715-6000
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 401
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-924-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17226101YA0400X
IL149-01018511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)