Provider Demographics
NPI:1578546156
Name:WORDEN, MARY E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:WORDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:WORDEN-MCGUINNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2901 S MICHIGAN AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3297
Mailing Address - Country:US
Mailing Address - Phone:312-671-4499
Mailing Address - Fax:312-698-5048
Practice Address - Street 1:5536 S EVERETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1902
Practice Address - Country:US
Practice Address - Phone:312-671-4499
Practice Address - Fax:312-698-5048
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204469Medicare PIN