Provider Demographics
NPI:1891990370
Name:CAHILL, MARY AILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:AILEEN
Last Name:CAHILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 WEST 107TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1736
Mailing Address - Country:US
Mailing Address - Phone:773-445-7403
Mailing Address - Fax:
Practice Address - Street 1:2754 WEST 107TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1736
Practice Address - Country:US
Practice Address - Phone:773-445-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633180OtherBCBS PROVIDER NO