Provider Demographics
NPI:1053172189
Name:KATSAHNIAS, MARY J (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:KATSAHNIAS
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 1:6920 ZACHARY DR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3372
Mailing Address - Country:US
Mailing Address - Phone:719-237-6922
Mailing Address - Fax:
Practice Address - Street 1:29W170 BUTTERFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2807
Practice Address - Country:US
Practice Address - Phone:630-447-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490240641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical