Provider Demographics
NPI:1477738086
Name:SMITH, MARIANN (LCPC, LMFT, CADC)
Entity Type:Individual
Prefix:MS
First Name:MARIANN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC, LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR
Mailing Address - Street 2:320
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1356
Mailing Address - Country:US
Mailing Address - Phone:847-971-7810
Mailing Address - Fax:847-759-9440
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:320
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-971-7810
Practice Address - Fax:847-496-5532
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23210101YA0400X
IL166.000847106H00000X
IL180.007132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist