Provider Demographics
NPI:1255667390
Name:FEARN, RASHIDA C (LCSW)
Entity Type:Individual
Prefix:
First Name:RASHIDA
Middle Name:C
Last Name:FEARN
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 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 1-F
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:773-450-1044
Mailing Address - Fax:
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 1-F
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:773-450-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0137071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical