Provider Demographics
NPI:1235804311
Name:MCGOVERN, CHERYLANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYLANN
Middle Name:MARIE
Last Name:MCGOVERN
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 1:203 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8073
Mailing Address - Country:US
Mailing Address - Phone:779-200-1043
Mailing Address - Fax:
Practice Address - Street 1:203 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8073
Practice Address - Country:US
Practice Address - Phone:779-200-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0171861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical