Provider Demographics
NPI:1760655542
Name:CASUCCI, DEANNA LYNN (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:CASUCCI
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E LAKE ST
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1179
Mailing Address - Country:US
Mailing Address - Phone:184-721-2337
Mailing Address - Fax:
Practice Address - Street 1:125 E LAKE ST
Practice Address - Street 2:SUITE #106
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1179
Practice Address - Country:US
Practice Address - Phone:184-721-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17928101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)