MEDICARE: MARY LENTINE 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	149-000819	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149-000819	OTHER	IL	LCSW

General Provider Information

NPI Number	:	1871626317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LENTINE LCSW

Provider Business Mailing Address
First Line	:	4 POTAWATOMIE TRL APT 2
Second Line	:
City	:	INDIAN HEAD PARK
State	:	IL
Zip	:	60525-9069
Country	:	US
Telephone Number	:	214-251-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 POTAWATOMIE TRL APT 2
Second Line	:
City	:	INDIAN HEAD PARK
State	:	IL
Zip	:	60525-9069
Country	:	US
Telephone Number	:	214-251-9935
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/13/2022

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