Provider Demographics
NPI:1962785576
Name:GRUBER, MARY KATHLEEN MCGOWAN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN MCGOWAN
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1813
Mailing Address - Country:US
Mailing Address - Phone:847-702-2218
Mailing Address - Fax:847-677-4183
Practice Address - Street 1:9150 CRAWFORD AVE STE 107
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1769
Practice Address - Country:US
Practice Address - Phone:847-702-2218
Practice Address - Fax:847-677-4183
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490056821041C0700X
IL149-0056821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical