Individual
MARYANN BASISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1315 BUTTERFIELD RD, SUITE 220, DOWNERS GROVE, IL 60515-5602
(630) 788-8040
(630) 424-0425
Mailing address
1315 BUTTERFIELD RD, SUITE 220, DOWNERS GROVE, IL 60515-5602
(630) 788-8040
(630) 424-0425
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149 006503
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11713175
CAQH
IL
01
—
183695
VALUE OPTIONS
TX
01
—
2167954
COMPSYCH
IL
01
—
2221790
BCBS
IL
01
—
2567375
CIGNA
MN
01
—
506974809
UBH
TX
01
—
7851779
AETNA
CT
01
—
813202000
MAGELLAN
MD
01
—
9426416
PHCS
IL
Enumeration date
08/26/2006
Last updated
06/22/2013
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