Provider Demographics
NPI:1609286327
Name:HERNAN, MARY KATHERINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHERINE
Last Name:HERNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:SARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:615 N PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1243
Mailing Address - Country:US
Mailing Address - Phone:309-543-4431
Mailing Address - Fax:309-543-2089
Practice Address - Street 1:932 N RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3721
Practice Address - Country:US
Practice Address - Phone:217-788-3948
Practice Address - Fax:217-527-3209
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490166111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149016611OtherLCSW LICENSE