Provider Demographics
NPI:1083259857
Name:FERENC, MARIOLA (LCSW)
Entity type:Individual
Prefix:
First Name:MARIOLA
Middle Name:
Last Name:FERENC
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PLAZA DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5508
Mailing Address - Country:US
Mailing Address - Phone:708-745-6555
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 344
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3208
Practice Address - Country:US
Practice Address - Phone:480-613-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.024796101YP2500X
104100000X
AZLCSW-227761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker