Provider Demographics
NPI:1205958345
Name:MARINELLI, BEVERLY JOAN (MS LCPC)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JOAN
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:BEV
Other - Middle Name:J
Other - Last Name:MARINELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS LCPC
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:ADVOCATE FAMILY CARE NETWORK
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60454-0776
Mailing Address - Country:US
Mailing Address - Phone:800-216-1110
Mailing Address - Fax:708-346-4868
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE LL5
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:800-216-1110
Practice Address - Fax:708-346-4868
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002684101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor