Provider Demographics
NPI:1568668515
Name:HARTNETT, MARY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:HARTNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 N HARLEM AVE
Mailing Address - Street 2:APT 503
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3759
Mailing Address - Country:US
Mailing Address - Phone:708-848-1922
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 620
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1136
Practice Address - Country:US
Practice Address - Phone:708-359-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0131251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical