| Kathy Mcnulty, Lcsw, Llc | |
|
2100 Manchester Rd Suite 400 Wheaton IL 60187 | |
| (630) 664-6036 | |
| Not Available |
| Full Name | Kathy Mcnulty, Lcsw, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2100 Manchester Rd, Wheaton, Illinois |
| Authorized Official Name and Position | Kathy Mcnulty (OWNER) |
| Authorized Official Contact | 6306646036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathy Mcnulty, Lcsw, Llc 2100 Manchester Rd Suite 400 Wheaton IL 60187 Ph: (630) 664-6036 | Kathy Mcnulty, Lcsw, Llc 2100 Manchester Rd Suite 400 Wheaton IL 60187 Ph: (630) 664-6036 |
| NPI Number | 1215388939 |
|---|---|
| Provider Enumeration Date | 06/23/2016 |
| Last Update Date | 08/20/2024 |
| Certification Date | 08/20/2024 |
| Medicare PECOS PAC ID | 4183919269 |
|---|---|
| Medicare Enrollment ID | O20160829001686 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215388939 | NPI | - | NPPES |
| 149-004463 | Other | IL | PROFESSIONAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 149-004463 (Illinois) | Primary |
| Provider Name | Kathleen Mcnulty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124187596 PECOS PAC ID: 5193010288 Enrollment ID: I20160829002113 |
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