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 1:3225 HEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6248
Mailing Address - Country:US
Mailing Address - Phone:217-726-7300
Mailing Address - Fax:217-726-5989
Practice Address - Street 1:3225 HEDLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6248
Practice Address - Country:US
Practice Address - Phone:217-726-7300
Practice Address - Fax:217-726-5989
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490063061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical