Provider Demographics
NPI:1558487769
Name:MACDONALD, PARVINE MOBED (LCSW)
Entity Type:Individual
Prefix:
First Name:PARVINE
Middle Name:MOBED
Last Name:MACDONALD
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 1:600 W ROOSEVELT RD STE A2
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2301
Mailing Address - Country:US
Mailing Address - Phone:630-462-8810
Mailing Address - Fax:630-462-8820
Practice Address - Street 1:600 W ROOSEVELT RD STE A2
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2301
Practice Address - Country:US
Practice Address - Phone:630-462-8810
Practice Address - Fax:630-462-8820
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0033321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002228093OtherBLUE CROSS BLUE SHIELD
IL20-8252361OtherCIGNA HEALTH CARE