Provider Demographics
NPI:1932713989
Name:MENDICINO, NICOLETTE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:MENDICINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 BARHARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1076
Mailing Address - Country:US
Mailing Address - Phone:224-688-9055
Mailing Address - Fax:
Practice Address - Street 1:1375 E WOODFIELD RD # 220
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6068
Practice Address - Country:US
Practice Address - Phone:847-383-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional