Basic Information
| Provider Information | |||||||||
| NPI: | 1285304071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NADUPPARAMBIL | ||||||||
| FirstName: | MARIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2219 HIAWATHA PKWY | ||||||||
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| City: | WOODRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605173509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155709303 | ||||||||
| FaxNumber: | 8669509427 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 W LARAWAY RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604512461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155709303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2021 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 178017391 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.