Provider Demographics
NPI:1518174002
Name:BARNISH, MARY L
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:BARNISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9649 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3632
Mailing Address - Country:US
Mailing Address - Phone:708-352-3580
Mailing Address - Fax:
Practice Address - Street 1:9649 W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3632
Practice Address - Country:US
Practice Address - Phone:708-352-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
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