Healthcare Provider Details

I. General information

NPI: 1851426118
Provider Name (Legal Business Name): MAUREEN R. KELLY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E WASHINGTON ST SUITE 301
CHICAGO IL
60602-2152
US

IV. Provider business mailing address

50 E WASHINGTON ST SUITE 301
CHICAGO IL
60602-2152
US

V. Phone/Fax

Practice location:
  • Phone: 312-458-9132
  • Fax: 312-337-9243
Mailing address:
  • Phone: 312-252-9500
  • Fax: 312-337-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-002316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: