Provider Demographics
NPI:1619052651
Name:KASPER, MARIOLA (LSW)
Entity Type:Individual
Prefix:MS
First Name:MARIOLA
Middle Name:
Last Name:KASPER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:MARIOLA
Other - Middle Name:
Other - Last Name:GONCIARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1533 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1305
Mailing Address - Country:US
Mailing Address - Phone:708-769-0610
Mailing Address - Fax:
Practice Address - Street 1:3249 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4360
Practice Address - Country:US
Practice Address - Phone:773-371-3711
Practice Address - Fax:773-282-6698
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker