Provider Demographics
NPI:1104194802
Name:ANASTASI, MARY (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ANASTASI
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PHD
Mailing Address - Street 1:200 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3213
Mailing Address - Country:US
Mailing Address - Phone:847-728-0822
Mailing Address - Fax:
Practice Address - Street 1:36 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4059
Practice Address - Country:US
Practice Address - Phone:512-788-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490095861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical