Provider Demographics
NPI:1740640879
Name:MISIASZEK, AGNIESZKA MAGDALENA (LCPC)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MAGDALENA
Last Name:MISIASZEK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:MAGDALENA
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:288 BROOKHAVEN TRL
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9161
Mailing Address - Country:US
Mailing Address - Phone:708-404-2387
Mailing Address - Fax:
Practice Address - Street 1:321 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2148
Practice Address - Country:US
Practice Address - Phone:708-404-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010207101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional