Provider Demographics
NPI:1154977544
Name:ROSSI, PATRICK (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ROSSI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N 5620W RD
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-7720
Mailing Address - Country:US
Mailing Address - Phone:630-849-5665
Mailing Address - Fax:
Practice Address - Street 1:241 N 5620W RD
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-7720
Practice Address - Country:US
Practice Address - Phone:630-849-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1490187861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical