Provider Demographics
NPI:1982424628
Name:MACLIN, BETH (MSW LCSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MACLIN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2440
Mailing Address - Country:US
Mailing Address - Phone:708-288-0852
Mailing Address - Fax:
Practice Address - Street 1:19150 S KEDZIE AVENUE
Practice Address - Street 2:#200
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-274-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0278901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical