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1396969242
C MARK MASSULLO
CHICAGO, IL
NPI
1396969242
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: IL 149-007721)
Enumeration Date
2007-04-12
Last Update Date
2012-09-16
Business Address
-- C MARK MASSULLO LCSW
3166 N LINCOLN AVE 310
CHICAGO, IL 60657-3133
Phone number: 773-296-9876
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Mailing Address
-- C MARK MASSULLO LCSW
3166 N LINCOLN AVE 310
CHICAGO, IL 60657-3133
Phone number:
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