Provider Demographics
NPI:1477830859
Name:HEARD, ANTHONY MODONI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MODONI
Last Name:HEARD
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 1:2021 N KEDZIE AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3786
Mailing Address - Country:US
Mailing Address - Phone:405-627-0691
Mailing Address - Fax:
Practice Address - Street 1:2021 N KEDZIE AVE APT 3C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3786
Practice Address - Country:US
Practice Address - Phone:405-627-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490147441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical