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 THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCPC
Authorized Official - Phone:630-570-0525
Mailing Address - Street 1:201 CHANTICLEER LN.
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-5022
Mailing Address - Country:US
Mailing Address - Phone:630-570-0525
Mailing Address - Fax:630-429-9742
Practice Address - Street 1:15 SPINNING WHEEL ROAD.
Practice Address - Street 2:SUITE 418
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7665
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:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL322761301-60521-30Medicaid