Basic Information
| Provider Information | |||||||||
| NPI: | 1962138214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARAL | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE STE C | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604623463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15127 S 73RD AVE STE C | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604623463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 150108436 | IL | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.