=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275669178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA KEATING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10001 GRAND AVE
-----------------------------------------------------
City | FRANKLIN PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60131-2563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-451-0330
-----------------------------------------------------
Fax | 847-451-1652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 521 S LINCOLN LN
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-451-0330
-----------------------------------------------------
Fax | 847-451-1652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DENNIS VACCARO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 847-451-0330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------