Provider Demographics
NPI:1477603405
Name:FALLON, KEVIN (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FALLON
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7442 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2019
Mailing Address - Country:US
Mailing Address - Phone:708-309-2943
Mailing Address - Fax:708-771-1682
Practice Address - Street 1:7442 HARRISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2019
Practice Address - Country:US
Practice Address - Phone:708-309-2943
Practice Address - Fax:708-771-1682
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical