Provider Demographics
NPI:1316360563
Name:AMES, PATRICK KENT (LCSW)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:KENT
Last Name:AMES
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 1:132 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3206
Mailing Address - Country:US
Mailing Address - Phone:224-639-2607
Mailing Address - Fax:
Practice Address - Street 1:255 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-1604
Practice Address - Country:US
Practice Address - Phone:224-639-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical