Provider Demographics
NPI:1184932923
Name:DUGAN-MARX, MARY C (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:DUGAN-MARX
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2762
Mailing Address - Country:US
Mailing Address - Phone:219-916-4271
Mailing Address - Fax:
Practice Address - Street 1:612 S 20TH ST
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2762
Practice Address - Country:US
Practice Address - Phone:219-916-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005614A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical