Provider Demographics
NPI:1548324312
Name:DIVIETRO, JAMEY (MA, LCPC)
Entity type:Individual
Prefix:MR
First Name:JAMEY
Middle Name:
Last Name:DIVIETRO
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 WHITEWAY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5275
Mailing Address - Country:US
Mailing Address - Phone:630-717-5657
Mailing Address - Fax:
Practice Address - Street 1:1288 RICKERT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0951
Practice Address - Country:US
Practice Address - Phone:630-717-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor