Provider Demographics
NPI:1861750531
Name:FIRESTONE, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:FIRESTONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, AM
Mailing Address - Street 1:2207 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3114
Mailing Address - Country:US
Mailing Address - Phone:773-384-5802
Mailing Address - Fax:
Practice Address - Street 1:2207 N MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3114
Practice Address - Country:US
Practice Address - Phone:773-384-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0134601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical