Provider Demographics
NPI:1407399538
Name:MAIELLO, JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MAIELLO
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 1:143 FIRST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 FIRST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3101
Practice Address - Country:US
Practice Address - Phone:630-247-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0189501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical