Provider Demographics
NPI:1164066718
Name:MCBOOM, JANELL LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:LYNN
Last Name:MCBOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANELL
Other - Middle Name:LYNN
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1106 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3207
Mailing Address - Country:US
Mailing Address - Phone:815-931-2253
Mailing Address - Fax:
Practice Address - Street 1:250 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8313
Practice Address - Country:US
Practice Address - Phone:815-740-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0198131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical