Provider Demographics
NPI:1235968207
Name:FOGERTY, HARRIET (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:
Last Name:FOGERTY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 W FOSTER AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2540
Mailing Address - Country:US
Mailing Address - Phone:630-251-2594
Mailing Address - Fax:
Practice Address - Street 1:4846 N CLARK ST STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7925
Practice Address - Country:US
Practice Address - Phone:312-574-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional