Healthcare Provider Details

I. General information

NPI: 1285550871
Provider Name (Legal Business Name): MARY SIROIS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 W IRVING PARK RD
CHICAGO IL
60641-2718
US

IV. Provider business mailing address

4943 W BELLE PLAINE AVE APT 2A
CHICAGO IL
60641-1767
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129410
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: