Provider Demographics
NPI:1821110826
Name:RACIOPPO, BARBARA SCHOLTS (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SCHOLTS
Last Name:RACIOPPO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3793
Mailing Address - Country:US
Mailing Address - Phone:847-247-0816
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3793
Practice Address - Country:US
Practice Address - Phone:847-247-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist