MEDICARE: MEGAN MANTILLA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801108376	MI
2	1041C0700X	Clinical Social Worker	9644	FL
3	1041C0700X	Clinical Social Worker	095794	NY
4	1041C0700X	Clinical Social Worker	LC200002376	DC
5	1041C0700X	Clinical Social Worker	34012010A	IN
6	1041C0700X	Clinical Social Worker	TLS213CP	SC
7	1041C0700X	Clinical Social Worker	30037	MD
8	1041C0700X	Clinical Social Worker	149.025209	IL
9	1041C0700X	Clinical Social Worker	0904014947	VA

General Provider Information

NPI Number	:	1457846636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MANTILLA LCSW

Provider Business Mailing Address
First Line	:	244 S RANDALL RD
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-5529
Country	:	US
Telephone Number	:	224-223-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 CANTERFIELD PKWY W
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-9021
Country	:	US
Telephone Number	:	224-223-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	04/24/2026

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