1144385311 NPI number — DEBORAH ANN MANTOVANI MSW, LCSW

Table of content: DEBORAH ANN MANTOVANI MSW, LCSW (NPI 1144385311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144385311 NPI number — DEBORAH ANN MANTOVANI MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANTOVANI
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENN
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144385311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 N. RIVER RD. SUITE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-718-0717
Provider Business Mailing Address Fax Number:
630-718-0747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FOX VALLEY INSTITUTE
Provider Second Line Business Practice Location Address:
640 N. RIVER RD. UNIT 108
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
60563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-544-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149003863 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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