Provider Demographics
NPI:1942963137
Name:STEVENS, MAHAL
Entity Type:Individual
Prefix:
First Name:MAHAL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 N GREENVIEW AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3449
Mailing Address - Country:US
Mailing Address - Phone:734-489-2330
Mailing Address - Fax:
Practice Address - Street 1:1542 W DEVON AVE APT 208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1344
Practice Address - Country:US
Practice Address - Phone:773-465-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker