Provider Demographics
NPI:1952667891
Name:GORMAN, MARIE ELLEN (MSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELLEN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ILLINOIS BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3314
Mailing Address - Country:US
Mailing Address - Phone:847-884-6212
Mailing Address - Fax:
Practice Address - Street 1:1 ILLINOIS BLVD
Practice Address - Street 2:STE 107
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3314
Practice Address - Country:US
Practice Address - Phone:847-884-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor