Provider Demographics
NPI:1043830771
Name:LASICA, ROBERT A (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:LASICA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 SPRING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2243
Mailing Address - Country:US
Mailing Address - Phone:630-842-4477
Mailing Address - Fax:
Practice Address - Street 1:144 SPRING OAKS DR
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-2243
Practice Address - Country:US
Practice Address - Phone:630-842-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490198161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical