Provider Demographics
NPI:1174799027
Name:BALL, MARY C (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3733
Mailing Address - Country:US
Mailing Address - Phone:847-717-5430
Mailing Address - Fax:847-695-4394
Practice Address - Street 1:611 W THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3733
Practice Address - Country:US
Practice Address - Phone:847-717-5430
Practice Address - Fax:847-695-4394
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0092471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical