Provider Demographics
NPI:1689720831
Name:LISIECKI, JOSEPH P JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:LISIECKI
Suffix:JR
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 1:15621 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5165
Mailing Address - Country:US
Mailing Address - Phone:708-532-7066
Mailing Address - Fax:
Practice Address - Street 1:15621 HEATHER CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5165
Practice Address - Country:US
Practice Address - Phone:708-532-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
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