Provider Demographics
NPI:1194943019
Name:MAZZONE, GERALYN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:L
Last Name:MAZZONE
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 1:5453 W HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1317
Mailing Address - Country:US
Mailing Address - Phone:773-841-0088
Mailing Address - Fax:
Practice Address - Street 1:307 N MICHIGAN AVE
Practice Address - Street 2:2024
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5311
Practice Address - Country:US
Practice Address - Phone:312-372-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490043691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical