Provider Demographics
NPI:1790395077
Name:MCALLISTER, MARY EILEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27334 N BANKSTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:IA
Mailing Address - Zip Code:52065-9723
Mailing Address - Country:US
Mailing Address - Phone:563-599-9140
Mailing Address - Fax:
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1811
Practice Address - Country:US
Practice Address - Phone:319-774-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker