Healthcare Provider Details

I. General information

NPI: 1629450986
Provider Name (Legal Business Name): ELIZABETH PIASECKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N RIDGEWAY AVE
CHICAGO IL
60624-1232
US

IV. Provider business mailing address

3321 S 61ST CT
CICERO IL
60804-3726
US

V. Phone/Fax

Practice location:
  • Phone: 773-265-4307
  • Fax: 773-265-4385
Mailing address:
  • Phone: 773-265-4307
  • Fax: 773-265-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012128
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: