Provider Demographics
NPI:1396729307
Name:FOSCO, DEBORAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:FOSCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LAKE STREET
Mailing Address - Street 2:SUITE 515
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-848-2631
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE STREET
Practice Address - Street 2:SUITE 515
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-848-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL396350Medicare PIN