Provider Demographics
NPI:1962874495
Name:GUARDINI, LUCIANA ANGELICA (LCSW)
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:ANGELICA
Last Name:GUARDINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7947
Mailing Address - Country:US
Mailing Address - Phone:217-419-8374
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH CHESTNUT STREET
Practice Address - Street 2:SUITE 244
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-621-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490164511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical