Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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C Mark Massullo, LCSW

Individual provider Clinical Social Worker · NPI 1396969242

C Mark Massullo, LCSW is a Clinical Social Worker in Chicago, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2007
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3166 N Lincoln Ave 310
Chicago, IL 60657-3133
Phone: (773) 296-9876
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149-007721 (IL)

Record details

NPI number1396969242
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedApril 12, 2007
Last updated in NPPESSeptember 16, 2012

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