Provider Demographics
NPI:1366071854
Name:CROSS, JOCELYN R (LCSW)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:R
Last Name:CROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRONZE POINTE S STE A
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8307
Mailing Address - Country:US
Mailing Address - Phone:618-207-2547
Mailing Address - Fax:
Practice Address - Street 1:2 BRONZE POINTE S STE A
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8307
Practice Address - Country:US
Practice Address - Phone:618-207-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490187021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149018702OtherCLINICAL SOCIAL WORK LICENSE