Provider Demographics
NPI:1720098742
Name:STORIE, MARY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:STORIE
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 1:1733 S LALONDE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:815-725-1440
Mailing Address - Fax:815-725-1550
Practice Address - Street 1:300 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6520
Practice Address - Country:US
Practice Address - Phone:815-725-1440
Practice Address - Fax:815-725-1550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232165OtherBLUE CROSS BLUE SHIELD
IL0007689557OtherAETNA
IL02232165OtherBLUE CROSS BLUE SHIELD