Provider Demographics
NPI:1881639292
Name:NAUGLE, MARY (LCPC, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NAUGLE
Suffix:
Gender:F
Credentials:LCPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 FOREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4374
Mailing Address - Country:US
Mailing Address - Phone:815-877-0900
Mailing Address - Fax:
Practice Address - Street 1:7225 FOREST HILLS RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4374
Practice Address - Country:US
Practice Address - Phone:815-877-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003366101YP2500X
IL1490097931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10126478OtherBLUE SHIELD OF IL PROV #
IL175274OtherCOM PSYCH
IL7200619OtherAETNA PROVIDER #