Provider Demographics
NPI:1134721657
Name:LORUSSO, LUCIANA F (CADC)
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:F
Last Name:LORUSSO
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30W450 LYSLE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-2400
Mailing Address - Country:US
Mailing Address - Phone:630-723-8288
Mailing Address - Fax:
Practice Address - Street 1:30W450 LYSLE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:IL
Practice Address - Zip Code:60184-2400
Practice Address - Country:US
Practice Address - Phone:630-723-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)