Mary A Davis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149006749 Issued in IL

Practice address

2430 Plainfield Rd Ste 2D
Crest Hill, IL 60403-1467

Phone

(815) 302-3895

NPI assigned

Jan 30, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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 and National Provider Directory roles.

• The Sykes Group, LTD

  • Professional Counselor
  • Joliet, IL
  • NPI 1093026346
  NPD (past)

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1962640870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 PLAINFIELD RD",
            "address_2": "2D",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604031467",
            "telephone_number": "815-302-3895",
            "fax_number": "815-302-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 PLAINFIELD RD STE 2D",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604031467",
            "telephone_number": "815-302-3895"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "822 N 129th Infantry Dr",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604353105",
            "country_code": "US",
            "telephone_number": "815-823-8460",
            "fax_number": "815-823-8461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149006749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crest Hill Dental Studio
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• Jenalee Demarco, SLP
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• James F Derk, D.P.M.
• Aamirah Jeelani Dhar, M.D.

• Clinical Social Worker in Crest Hill, IL
• Providers in Crest Hill, 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 Mar 17, 2018; 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.