Doctor Name: | PATRICIA LALLISH |
NPI Number: | 1962856310 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 149.016663 |
Business Practice Address: | 325 Spring St Red Bud, IL - 622781105 |
Business Phone Number: | 6182825420 |
Business Fax Number: | |
Mailing Address: | 24 Trailridge Ln, GLEN CARBON |
State: | IL |
Postal Code: | 620341834 |
Phone Number: | 6187805256 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2016 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.016663 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |