Provider Demographics
NPI:1073787685
Name:ABBOTT, MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:ABBOTT
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 1:3062 MOSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8943
Mailing Address - Country:US
Mailing Address - Phone:847-341-1380
Mailing Address - Fax:
Practice Address - Street 1:3062 MOSEDALE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-8943
Practice Address - Country:US
Practice Address - Phone:847-341-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0128271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical