Provider Demographics
NPI:1952546327
Name:MARY GRANT-ANGIOLETTI
Entity Type:Organization
Organization Name:MARY GRANT-ANGIOLETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCAIL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT-ANGIOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-452-3099
Mailing Address - Street 1:9 S FAIRVIEW AVE
Mailing Address - Street 2:203
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4033
Mailing Address - Country:US
Mailing Address - Phone:847-452-3099
Mailing Address - Fax:
Practice Address - Street 1:9 S FAIRVIEW AVE
Practice Address - Street 2:203
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4033
Practice Address - Country:US
Practice Address - Phone:847-452-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149002546251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health