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Organization
PROVENA ST MARYS HOSPITAL
Active
Organization
PROVENA ST MARYS HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY S LEE LCSW CADC (EAP SUBSTANCE ABUSE COUNSELOR)
(815) 937-2081
Entity
Organization
Contact information
Practice address
21 HERITAGE DRIVE, SUITE 102, BOURBONNAIS, IL 60914
(815) 937-2081
(815) 937-8798
Mailing address
21 HERITAGE DRIVE, SUITE 102, BOURBONNAIS, IL 60914
(815) 937-2081
(815) 937-8798
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149006455
IL
Other
Enumeration date
05/19/2008
Last updated
05/19/2008
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