Healthcare Provider Details

I. General information

NPI: 1609690999
Provider Name (Legal Business Name): FRANK PISANO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST
OAK PARK IL
60302-3257
US

IV. Provider business mailing address

212 S MARION ST
OAK PARK IL
60302-3257
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: