Provider Demographics
NPI:1063697696
Name:SMITH, MARY ANN CUSHING (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:CUSHING
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4658
Mailing Address - Country:US
Mailing Address - Phone:630-968-6727
Mailing Address - Fax:630-964-1126
Practice Address - Street 1:5116 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4658
Practice Address - Country:US
Practice Address - Phone:630-968-6727
Practice Address - Fax:630-964-1126
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-0014100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional