Provider Demographics
NPI:1730274804
Name:MASTIO, GAIL E (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:MASTIO
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 1:36W958 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5081
Mailing Address - Country:US
Mailing Address - Phone:630-513-5213
Mailing Address - Fax:
Practice Address - Street 1:1120 RANDALL CT
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3911
Practice Address - Country:US
Practice Address - Phone:630-232-1070
Practice Address - Fax:630-232-1471
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK05634Medicare ID - Type Unspecified
ILQ12699Medicare UPIN