Provider Demographics
NPI:1184841009
Name:ROSSETTO, REGINA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:ROSSETTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 W OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5122
Mailing Address - Country:US
Mailing Address - Phone:773-725-2448
Mailing Address - Fax:
Practice Address - Street 1:5341 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2817
Practice Address - Country:US
Practice Address - Phone:708-656-6430
Practice Address - Fax:708-656-6591
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490066721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617631OtherBLUE CROSS BLUE SHIELD
IL202591OtherMEDICARE
IL149006672Medicaid