Individual
JAMES JOSEPH MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
418 N HARVEY AVE, OAK PARK, IL 60302-2337
(914) 953-3889
Mailing address
418 N HARVEY AVE, OAK PARK, IL 60302-2337
(914) 953-3889
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180.014161
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15074728
CAQH PROVIEW
IL
01
—
180.014161
STATE LICENSE
IL
Enumeration date
01/20/2021
Last updated
11/25/2022
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