Healthcare Provider Details

I. General information

NPI: 1477723963
Provider Name (Legal Business Name): MARY ANN MCMORROW PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST ROOM 921
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

345 E SUPERIOR ST ROOM 921
CHICAGO IL
60611-2654
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-8440
  • Fax: 312-238-5925
Mailing address:
  • Phone: 312-238-8440
  • Fax: 312-238-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071006273
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071006273
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071006273
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: