Provider Demographics
NPI:1982597423
Name:WESTENBERGER, MAGEN SELESTE (LCSW)
Entity type:Individual
Prefix:
First Name:MAGEN
Middle Name:SELESTE
Last Name:WESTENBERGER
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 1:9 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6723
Mailing Address - Country:US
Mailing Address - Phone:314-221-6725
Mailing Address - Fax:
Practice Address - Street 1:9 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6723
Practice Address - Country:US
Practice Address - Phone:314-221-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490241211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical