Provider Demographics
NPI:1063894038
Name:MAGINN, MARK SHERIDAN (MSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SHERIDAN
Last Name:MAGINN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N CLIFTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4122
Mailing Address - Country:US
Mailing Address - Phone:773-666-5285
Mailing Address - Fax:
Practice Address - Street 1:2150 N CLIFTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4122
Practice Address - Country:US
Practice Address - Phone:773-666-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0034031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical