Provider Demographics
NPI:1255954772
Name:FALOTICO, KATHLEEN HELEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HELEN
Last Name:FALOTICO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:H
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 W COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2536
Mailing Address - Country:US
Mailing Address - Phone:847-630-2046
Mailing Address - Fax:
Practice Address - Street 1:540 W COLFAX ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2536
Practice Address - Country:US
Practice Address - Phone:847-630-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0087591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical