Basic Information
| Provider Information | |||||||||
| NPI: | 1407358716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEASA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6606 W WINDSOR AVE APT Q1 | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604023594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735160927 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2653 W OGDEN AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732576672 | ||||||||
| FaxNumber: | 7732575330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2018 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.010869 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.