Provider Demographics
NPI:1437845401
Name:GATTI, JAMES OWEN (LISW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:OWEN
Last Name:GATTI
Suffix:
Gender:M
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1617
Mailing Address - Country:US
Mailing Address - Phone:563-328-5826
Mailing Address - Fax:563-323-1631
Practice Address - Street 1:415 N PERRY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1617
Practice Address - Country:US
Practice Address - Phone:563-328-5826
Practice Address - Fax:563-323-1631
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.025258104100000X
IA081067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker