Provider Demographics
NPI:1114814365
Name:PORCARO, ANTHONY JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:PORCARO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2828
Mailing Address - Country:US
Mailing Address - Phone:630-915-6644
Mailing Address - Fax:
Practice Address - Street 1:6800 JOLIET RD
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-4460
Practice Address - Country:US
Practice Address - Phone:708-246-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0279881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical