Provider Demographics
NPI:1942695226
Name:ANTOINETTE M DEZZUTTI LCSW PC
Entity Type:Organization
Organization Name:ANTOINETTE M DEZZUTTI LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEZZUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-891-6729
Mailing Address - Street 1:6237 N LAKEWOOD AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:954 W WASHINGTON BLVD
Practice Address - Street 2:STE 402 BOX 14
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2224
Practice Address - Country:US
Practice Address - Phone:773-891-6729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty