Nicholas G. Lattanzio, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010700 Issued in IL

Practice address

405 Illinois Ave Unit 2C
St Charles, IL 60174-2963

Phone

(630) 377-3535

NPI assigned

Jan 8, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1346901667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 ILLINOIS AVENUE",
            "address_2": "SUITES 2B, 2C, & 2D",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-377-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 ILLINOIS AVE UNIT 2C",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742963",
            "telephone_number": "630-377-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATTANZIO",
        "first_name": "NICHOLAS",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-08",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Doxy",
            "affiliation": "N",
            "endpointDescription": "Application for telehealth services that is HIPPA compliant and allows for exchange of information with authorized representatives and providers.",
            "address_1": "405 Illinois Ave Ste 2B2C&2D",
            "city": "St Charles",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601742963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Herman Paul Langner, M.D.
• Jeffrey Gerard Larson
• Laura Elizabeth Larson, LCSW
• Matthew Paul Larson, CADC, RYT200
• Lara Lasky, MPH, CD
• Connor Lavallie, DC
• Natalia Elizabeth Lavallie, DC
• Chloe Le
• Tuyen Phuong Le, PHARMD
• Leading With Love Wellness Center, Inc.

• Clinical Psychologist in St Charles, IL
• Providers in St Charles, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.