MEDICARE: LAURA PACETTI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	355132	OTHER	IL	MHN/TRICARE
2	740800	OTHER	IL	MAGELLAN
3	01635477	OTHER	IL	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1881683514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PACETTI LCSW

Provider Business Mailing Address
First Line	:	3622 WESLEY AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3861
Country	:	US
Telephone Number	:	708-263-9595
Fax Number	:	708-795-7022

Provider Business Practice Location Address
First Line	:	7350 W COLLEGE DR
Second Line	:	STE. 101
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1149
Country	:	US
Telephone Number	:	708-263-9595
Fax Number	:	708-795-7022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	07/08/2007

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Directions to “ LAURA PACETTI LCSW” Practice Location

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