Provider Demographics
NPI:1154916815
Name:MARESKI, MALLORY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:A
Last Name:MARESKI
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 1:111 N WABASH AVE, SUITE 100, #3946
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-5626
Mailing Address - Country:US
Mailing Address - Phone:708-573-1920
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE, SUITE 100, #3946
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-5626
Practice Address - Country:US
Practice Address - Phone:708-573-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0229861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical