Provider Demographics
NPI:1710480850
Name:TAD-Y, RAYMUNDO BERNARDO JR (LCPC, NCE, NCSC)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:BERNARDO
Last Name:TAD-Y
Suffix:JR
Gender:M
Credentials:LCPC, NCE, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 KILKENNY CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-6013
Mailing Address - Country:US
Mailing Address - Phone:847-962-5642
Mailing Address - Fax:
Practice Address - Street 1:447 KILKENNY CT
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-6013
Practice Address - Country:US
Practice Address - Phone:847-962-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL255467101YS0200X
IL180.009788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool