Provider Demographics
NPI:1972995884
Name:MARY FARRELLY
Entity Type:Organization
Organization Name:MARY FARRELLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:FARRELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:773-315-3430
Mailing Address - Street 1:6063 N OVERHILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3814
Mailing Address - Country:US
Mailing Address - Phone:773-315-3430
Mailing Address - Fax:
Practice Address - Street 1:6063 N OVERHILL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3814
Practice Address - Country:US
Practice Address - Phone:773-315-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.010895251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management