Provider Demographics
NPI:1073757134
Name:CHERULLO, MARY E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:CHERULLO
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 1:5000 S 5TH AVE
Mailing Address - Street 2:BUILDING 228
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 S. 5TH AVE
Practice Address - Street 2:BUILDING 228
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60414-3030
Practice Address - Country:US
Practice Address - Phone:773-870-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0135611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical