Provider Demographics
NPI:1538656723
Name:GORECKI NOWAK, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GORECKI NOWAK
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 1:510 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4052
Mailing Address - Country:US
Mailing Address - Phone:217-418-4199
Mailing Address - Fax:
Practice Address - Street 1:510 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4052
Practice Address - Country:US
Practice Address - Phone:217-418-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103101104100000X
IL149.0242671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker