Provider Demographics
NPI:1285767277
Name:MAZAILCA, CAROLYN BRANN (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:BRANN
Last Name:MAZAILCA
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:MAZAILCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:111 S GRANT
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-325-3704
Mailing Address - Fax:
Practice Address - Street 1:111 S GRANT
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-325-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232197OtherBLUE CROSS BLUE SHIELD