Provider Demographics
NPI:1083716112
Name:DALSANTO, KATHLEEN M (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DALSANTO
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18132 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2106
Mailing Address - Country:US
Mailing Address - Phone:708-957-3695
Mailing Address - Fax:708-957-3695
Practice Address - Street 1:18132 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2106
Practice Address - Country:US
Practice Address - Phone:708-957-3695
Practice Address - Fax:708-957-3695
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10757549OtherCAQH PROVIDER NUMBER
ILK35689Medicare ID - Type UnspecifiedPROVIDER NUMBER