Basic Information
| Provider Information | |||||||||
| NPI: | 1063901908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUDA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4759 N MAPLEWOOD AVE APT 406 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606257013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082633017 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5215 N CALIFORNIA AVE STE F101 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606250035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735615809 | ||||||||
| FaxNumber: | 7735615946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 150015534 | IL | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 149020747 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.