Provider Demographics
NPI:1548650179
Name:DI PIRRO, KELSEY (LMSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DI PIRRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2416
Mailing Address - Country:US
Mailing Address - Phone:810-614-1078
Mailing Address - Fax:
Practice Address - Street 1:830 N AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2416
Practice Address - Country:US
Practice Address - Phone:810-614-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
IL101YA0400X
IL149.0218221041C0700X
MI68010971431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)