Provider Demographics
NPI:1588296800
Name:DAGOSTINO, NANCY (LCPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:DAGOSTINO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4213
Mailing Address - Country:US
Mailing Address - Phone:847-208-5976
Mailing Address - Fax:847-208-5976
Practice Address - Street 1:2600 BEHAN RD STE E3
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-2224
Practice Address - Country:US
Practice Address - Phone:815-888-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014512101YP2500X
IL180013722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty