Healthcare Provider Details

I. General information

NPI: 1811950785
Provider Name (Legal Business Name): DEBORAH ANN MAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27255 N FAIRFIELD RD
MUNDELEIN IL
60060-9115
US

IV. Provider business mailing address

136 MCKINSTRY DR
ELGIN IL
60123-4929
US

V. Phone/Fax

Practice location:
  • Phone: 847-487-9455
  • Fax: 847-307-4140
Mailing address:
  • Phone: 224-805-3274
  • Fax: 847-622-8516

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: