Provider Demographics
NPI:1609097146
Name:MEYERS, MARY LYNN (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY LYNN
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 WEST LAKE AVENUEE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-2643
Mailing Address - Country:US
Mailing Address - Phone:847-828-6066
Mailing Address - Fax:
Practice Address - Street 1:1167 WILMETTE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2643
Practice Address - Country:US
Practice Address - Phone:847-828-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0144241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical