Provider Demographics
NPI:1477878445
Name:BENNETT PASQUALE, TERESA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BENNETT PASQUALE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:EILEEN
Other - Last Name:BENNETT PASQUALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1532 W FARGO AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1830
Mailing Address - Country:US
Mailing Address - Phone:312-723-9388
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5909
Practice Address - Country:US
Practice Address - Phone:847-475-7003
Practice Address - Fax:847-475-7333
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 97491041C0700X
IL149.0190781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical