Provider Demographics
NPI:1306137039
Name:MYERS, MARSONNE DENISE (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:MARSONNE
Middle Name:DENISE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N CROSS ST
Mailing Address - Street 2:UNIT 534
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5368
Mailing Address - Country:US
Mailing Address - Phone:630-723-1762
Mailing Address - Fax:
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:STE 206
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5855
Practice Address - Country:US
Practice Address - Phone:630-653-6441
Practice Address - Fax:630-653-8409
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0146351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical