Provider Demographics
NPI:1962095836
Name:FATTORI, JOSEPH (MCAP, RMHCI)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FATTORI
Suffix:
Gender:M
Credentials:MCAP, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-4335
Mailing Address - Country:US
Mailing Address - Phone:317-721-4477
Mailing Address - Fax:
Practice Address - Street 1:1900 BITTERSWEET DR
Practice Address - Street 2:
Practice Address - City:SAINT ANNE
Practice Address - State:IL
Practice Address - Zip Code:60964-4335
Practice Address - Country:US
Practice Address - Phone:317-721-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
IL180.017058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)