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General NPI Number Information
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NPI Number | 1972995884
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Entity Type | Organization
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Legal Business Name | MARY FARRELLY
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 6063 N OVERHILL AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3814
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Country | US
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Telephone | 773-315-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 6063 N OVERHILL AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3814
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Country | US
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Telephone | 773-315-3430
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. MARY FRANCIS FARRELLY
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Credential | LSW
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Telephone | 773-315-3430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 150.010895
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License Number State | IL
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