Provider Demographics
NPI:1124510565
Name:GORIS, MARIA E (RBT 17-44623)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:GORIS
Suffix:
Gender:F
Credentials:RBT 17-44623
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2523
Mailing Address - Country:US
Mailing Address - Phone:630-629-2696
Mailing Address - Fax:
Practice Address - Street 1:541 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2523
Practice Address - Country:US
Practice Address - Phone:630-629-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-44623106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician