Provider Demographics
NPI:1194535203
Name:RUSSO, MAUREEN BELLA (MA, ATR-P)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:BELLA
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MA, ATR-P
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ERIN
Other - Last Name:GUINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 LAKE ST STE 421
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1085
Mailing Address - Country:US
Mailing Address - Phone:708-303-8083
Mailing Address - Fax:
Practice Address - Street 1:1101 LAKE ST STE 421
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1085
Practice Address - Country:US
Practice Address - Phone:708-303-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health