Individual
C MARK MASSULLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3166 N LINCOLN AVE, 310, CHICAGO, IL 60657-3133
(773) 296-9876
Mailing address
3166 N LINCOLN AVE, 310, CHICAGO, IL 60657-3133
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-007721
IL
Other
Enumeration date
04/12/2007
Last updated
09/16/2012
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