Provider Demographics
NPI:1851758569
Name:PARADIS, JOAN M (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:PARADIS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:PARADIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:5145 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3661
Mailing Address - Country:US
Mailing Address - Phone:773-989-1609
Mailing Address - Fax:773-989-1645
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-989-1609
Practice Address - Fax:773-989-1645
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.015321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health