Provider Demographics
NPI:1225861941
Name:STAFF, MARK H (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:STAFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N 1ST ST STE 225
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3760
Mailing Address - Country:US
Mailing Address - Phone:217-788-4065
Mailing Address - Fax:217-788-4147
Practice Address - Street 1:901 N 1ST ST STE 225
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3760
Practice Address - Country:US
Practice Address - Phone:217-788-4065
Practice Address - Fax:217-788-4147
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490063061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical