Provider Demographics
NPI:1972062958
Name:FLAHERTY, PATRICIA B (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:B
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:210 S DESPLAINES ST APT 1407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5570
Mailing Address - Country:US
Mailing Address - Phone:312-493-3122
Mailing Address - Fax:
Practice Address - Street 1:210 S DESPLAINES ST APT 1407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-5570
Practice Address - Country:US
Practice Address - Phone:312-493-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29625101YA0400X
IL149.0199721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)