Provider Demographics
NPI:1194315762
Name:MASI, MARIA VICTORIA (LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:MASI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1471
Mailing Address - Country:US
Mailing Address - Phone:847-759-9110
Mailing Address - Fax:
Practice Address - Street 1:2737 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1564
Practice Address - Country:US
Practice Address - Phone:847-987-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490088681041C0700X
IL166000706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical