Provider Demographics
NPI:1427711274
Name:CALLOZZO, MARINA (LCSW)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:CALLOZZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W HURON ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5273
Mailing Address - Country:US
Mailing Address - Phone:773-972-3921
Mailing Address - Fax:
Practice Address - Street 1:1649 W HURON ST APT 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5273
Practice Address - Country:US
Practice Address - Phone:773-972-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0233491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical