Provider Demographics
NPI:1790105112
Name:LESSEM, ROSLYN (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:
Last Name:LESSEM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3443
Mailing Address - Country:US
Mailing Address - Phone:847-477-7343
Mailing Address - Fax:
Practice Address - Street 1:1652 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3443
Practice Address - Country:US
Practice Address - Phone:847-477-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional