Provider Demographics
NPI:1427297787
Name:PONZIANO, FRANK CHARLES JR (AAS CADC)
Entity type:Individual
Prefix:PROF
First Name:FRANK
Middle Name:CHARLES
Last Name:PONZIANO
Suffix:JR
Gender:M
Credentials:AAS CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 N 75TH AVE APT G
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2602
Mailing Address - Country:US
Mailing Address - Phone:773-981-0620
Mailing Address - Fax:
Practice Address - Street 1:211 WAUKEGAN RD
Practice Address - Street 2:ST.100
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2757
Practice Address - Country:US
Practice Address - Phone:847-446-2270
Practice Address - Fax:847-446-2172
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26662101YA0400X
101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health