Provider Demographics
NPI:1194717553
Name:MAZUREK, JOHN R (MSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:MAZUREK
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 1:637 E GOLF RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4967
Mailing Address - Country:US
Mailing Address - Phone:847-357-9611
Mailing Address - Fax:
Practice Address - Street 1:637 E GOLF RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4967
Practice Address - Country:US
Practice Address - Phone:847-357-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490024591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL462293000OtherMAGELLAN MIS
IL65820942OtherUNITED BEHAVIORAL HEALTH
IL01627745OtherBC B S OF IL
IL795380Medicare PIN