Provider Demographics
NPI:1487253720
Name:LATOSZEWSKI, ANDREW JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:LATOSZEWSKI
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 1:3430 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4523
Mailing Address - Country:US
Mailing Address - Phone:269-744-1247
Mailing Address - Fax:
Practice Address - Street 1:10537 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1933
Practice Address - Country:US
Practice Address - Phone:269-744-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149021779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health