Provider Demographics
NPI:1053507988
Name:REYNOLDS, MARY ELIZABETH (MA, MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, MSW
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Mailing Address - Street 1:1036 ELGIN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2856
Mailing Address - Country:US
Mailing Address - Phone:773-988-4952
Mailing Address - Fax:630-540-9366
Practice Address - Street 1:1036 ELGIN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2856
Practice Address - Country:US
Practice Address - Phone:773-988-4952
Practice Address - Fax:630-540-9366
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker