Provider Demographics
NPI:1508931858
Name:QUARESIMA, ROSE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANN
Last Name:QUARESIMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:ANN
Other - Last Name:QUARESIMA PATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:835 SOUTH FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-787-2566
Mailing Address - Fax:815-758-1430
Practice Address - Street 1:835 SOUTH FOURTH STREET
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-787-2566
Practice Address - Fax:815-758-1430
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
01923314OtherBLUE CROSS & BLUE SHIELD
01923314OtherBLUE CROSS & BLUE SHIELD