MEDICARE: MARY DURAN LCSW

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
1	1041C0700X	Clinical Social Worker	149022649	IL
2	1041C0700X	Clinical Social Worker	28461	CA

General Provider Information

NPI Number	:	1255579066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DURAN LCSW

Provider Business Mailing Address
First Line	:	2919 CROSSING CT STE 13
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-439-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 CROSSING CT STE 13
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-439-4035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/09/2023

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Directions to “ MARY DURAN LCSW” Practice Location

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