Provider Demographics
NPI:1275718272
Name:SENN, MARY E (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SENN
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1150
Mailing Address - Country:US
Mailing Address - Phone:847-528-4099
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5918
Practice Address - Country:US
Practice Address - Phone:847-328-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0108761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical