Healthcare Provider Details

I. General information

NPI: 1841236643
Provider Name (Legal Business Name): MARY ALEXANDRA PW DOTY MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALEX DOTY MSSW, LCSW

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W TOUHY AVE
CHICAGO IL
60645-2833
US

IV. Provider business mailing address

732 HINMAN AVE APT. 3E
EVANSTON IL
60202-4414
US

V. Phone/Fax

Practice location:
  • Phone: 773-508-1000
  • Fax: 773-262-7084
Mailing address:
  • Phone: 847-328-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: