Provider Demographics
NPI:1093474561
Name:TROVATO, MARY (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TROVATO
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1217
Mailing Address - Country:US
Mailing Address - Phone:708-334-3138
Mailing Address - Fax:
Practice Address - Street 1:2244 95TH ST STE 219
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8118
Practice Address - Country:US
Practice Address - Phone:708-404-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health