Provider Demographics
NPI:1306241906
Name:VERNASCO, ALEXANDRIA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:VERNASCO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 N MARINE DR APT 805
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1724
Mailing Address - Country:US
Mailing Address - Phone:630-398-0859
Mailing Address - Fax:
Practice Address - Street 1:4250 N MARINE DR APT 2227
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1746
Practice Address - Country:US
Practice Address - Phone:630-398-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490169771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical