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General NPI Number Information
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NPI Number | 1326850611
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Entity Type | Individual
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Provider Name | JOHN LISY LSW
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Gender | Male
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 380
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City | CHICAGO
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State | IL
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Zip | 60601-7710
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Country | US
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Telephone | 708-628-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 618 W BARRY AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60657-4566
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Country | US
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Telephone | 630-452-6797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150113247
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License Number State | IL
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