Provider Demographics
NPI:1871998567
Name:JEANA LUCARELLI MA PSY D HEALTH MANAGEMENT, INC
Entity type:Organization
Organization Name:JEANA LUCARELLI MA PSY D HEALTH MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:847-903-9611
Mailing Address - Street 1:318 W HALF DAY RD STE 326
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6547
Mailing Address - Country:US
Mailing Address - Phone:847-903-9611
Mailing Address - Fax:847-903-9611
Practice Address - Street 1:318 W HALF DAY RD STE 326
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6547
Practice Address - Country:US
Practice Address - Phone:847-903-9611
Practice Address - Fax:847-903-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty