Individual provider Active NPI

Mariellen M. Re, L.C.S.W./C.A.D.C.

  • Clinical Social Worker
  • Lake in the Hills, IL
National Provider Identifier
1669465340
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1303 W Algonquin Rd
Lake in the Hills, IL 60156-3575
Phone
(847) 854-8995
Fax
(847) 658-0787
NPI assigned
Aug 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X IL Primary

Addresses

Primary practice location

1303 W Algonquin Rd
Lake in the Hills, IL 60156-3575

Mailing address

1303 W Algonquin Rd
Lake in the Hills, IL 60156-3575
Phone (847) 854-8995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149-002312ILMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1669465340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 W ALGONQUIN RD",
            "city": "LAKE IN THE HILLS",
            "state": "IL",
            "postal_code": "601563575",
            "telephone_number": "847-854-8995",
            "fax_number": "847-658-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 W ALGONQUIN RD",
            "city": "LAKE IN THE HILLS",
            "state": "IL",
            "postal_code": "601563575",
            "telephone_number": "847-854-8995",
            "fax_number": "847-658-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RE",
        "first_name": "MARIELLEN",
        "middle_name": "M.",
        "credential": "L.C.S.W./C.A.D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake in the Hills, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.