Provider Demographics
NPI:1447225321
Name:MILLER, MARY JOANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOANNE
Last Name:MILLER
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 1:6115 N MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3914
Mailing Address - Country:US
Mailing Address - Phone:773-792-8586
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:145
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-685-9900
Practice Address - Fax:847-685-6390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL94979Medicare ID - Type Unspecified