Provider Demographics
NPI:1932598901
Name:DR. NICOLE LAROCCO PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DR. NICOLE LAROCCO PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:630-570-0525
Mailing Address - Street 1:211 W 59TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4923
Mailing Address - Country:US
Mailing Address - Phone:630-570-0525
Mailing Address - Fax:630-429-9742
Practice Address - Street 1:5757 S MADISON ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8116
Practice Address - Country:US
Practice Address - Phone:630-570-0525
Practice Address - Fax:630-429-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006949251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health