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NPI Code Detail

MEDICARE: MRS. MARY ANN CUSHING SMITH L.C.P.C.

MEDICARE: MRS. MARY ANN CUSHING SMITH L.C.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180-0014100IL

General Provider Information

NPI Number : 1063697696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ANN CUSHING SMITH L.C.P.C.
Provider Business Mailing Address
First Line : 5116 FOREST AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-4658
Country : US
Telephone Number : 630-968-6727
Fax Number : 630-964-1126
Provider Business Practice Location Address
First Line : 5116 FOREST AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-4658
Country : US
Telephone Number : 630-968-6727
Fax Number : 630-964-1126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2008
Last Update Date : 01/02/2008

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