Provider Demographics
NPI:1144266644
Name:PACIONE, ANTHONY J (MSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:PACIONE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5648
Mailing Address - Country:US
Mailing Address - Phone:847-692-6546
Mailing Address - Fax:
Practice Address - Street 1:2 W TALCOTT RD
Practice Address - Street 2:SUITE 34
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-830-1290
Practice Address - Fax:847-292-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490013071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26924Medicare ID - Type Unspecified