Healthcare Provider Details

I. General information

NPI: 1609286327
Provider Name (Legal Business Name): MARY KATHERINE HERNAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHERINE SARNES LCSW

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N RUTLEDGE ST
SPRINGFIELD IL
62702-3721
US

IV. Provider business mailing address

615 N PROMENADE ST
HAVANA IL
62644-1243
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3948
  • Fax: 217-527-3209
Mailing address:
  • Phone: 309-543-4431
  • Fax: 309-543-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016611
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: