Provider Demographics
NPI:1306983499
Name:GERRITY, MARY ANN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:GERRITY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W. GRAND PRAIRIE ST.
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:IL
Mailing Address - Zip Code:62451-1048
Mailing Address - Country:US
Mailing Address - Phone:618-586-2767
Mailing Address - Fax:
Practice Address - Street 1:304 W. GRAND PRAIRIE ST.
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:IL
Practice Address - Zip Code:62451-1048
Practice Address - Country:US
Practice Address - Phone:618-586-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health