Mary Ann Pawelko, LCSW, CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.010754 Issued in IL

Practice address

217 Goodnow Blvd
Round Lake, IL 60073-3217

Phone

(847) 223-2561

Fax

(847) 245-3573

NPI assigned

Feb 23, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Safe Harbor Chicago North

  • Mental Health Counselor
  • Round Lake, IL
  • NPI 1417077538
  NPD (past)

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1942440557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 N SUNRISE DR",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600734049",
            "telephone_number": "847-223-2561",
            "fax_number": "847-245-3573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 GOODNOW BLVD",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600733217",
            "telephone_number": "847-223-2561",
            "fax_number": "847-245-3573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAWELKO",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-23",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "23564",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Ogle
• Denise Victoria Pacifico Pajarillo, RPH
• Kassandra A Patankar, LCPC
• Shilpa K Patel, MS, CNS
• Snehal H Patel
• Jamie Pearlstein-Marion
• Derrick A Powell, LMT
• Precious Smiles Dental PC
• Brogan Repp
• Restored Home Health , LLC

• Clinical Social Worker in Round Lake, IL
• Providers in Round Lake, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.