Provider Demographics
NPI:1124602651
Name:FRACCARO, JOSH (LSW)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:FRACCARO
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 W EASTWOOD AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4866
Mailing Address - Country:US
Mailing Address - Phone:312-505-6551
Mailing Address - Fax:
Practice Address - Street 1:1416 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0939
Practice Address - Country:US
Practice Address - Phone:773-799-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501051431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical