Provider Demographics
NPI:1396169637
Name:MONAHAN, MARY ANN RUTH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:RUTH
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:MARY ANN
Other - Middle Name:RUTH
Other - Last Name:PUSATERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 SOUTH PRAIRIE AVENUE
Mailing Address - Street 2:#1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-339-1749
Mailing Address - Fax:773-254-8944
Practice Address - Street 1:735 W. 35TH STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-339-1749
Practice Address - Fax:773-254-8944
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health