Provider Demographics
NPI:1598931867
Name:PANOZZO, LISA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:PANOZZO
Suffix:
Gender:F
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:PO BOX 2351
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1030
Mailing Address - Country:US
Mailing Address - Phone:708-846-2869
Mailing Address - Fax:708-349-1464
Practice Address - Street 1:15915 S CRYSTAL CREEK DR
Practice Address - Street 2:UNIT E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9284
Practice Address - Country:US
Practice Address - Phone:708-846-2869
Practice Address - Fax:708-349-1464
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0122621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical