Provider Demographics
NPI:1831453968
Name:DEERING, MARY T (ACSW, LCSW, CADC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:DEERING
Suffix:
Gender:F
Credentials:ACSW, LCSW, CADC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:CHERULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:1205 N STERLING AVE
Mailing Address - Street 2:117
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8458
Mailing Address - Country:US
Mailing Address - Phone:630-363-5328
Mailing Address - Fax:
Practice Address - Street 1:1205 N STERLING AVE
Practice Address - Street 2:117
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8458
Practice Address - Country:US
Practice Address - Phone:630-363-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL27761101YA0400X
IL1490073981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)