Provider Demographics
NPI:1083125033
Name:MCCORMICK, ANNA BELLA (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BELLA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:PECYNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:561 W DIVERSEY PKWY STE 210A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1682
Mailing Address - Country:US
Mailing Address - Phone:630-336-3113
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 210A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:630-336-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102646104100000X
IL1490210521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker