Provider Demographics
NPI:1285304071
Name:NADUPPARAMBIL, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NADUPPARAMBIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 HIAWATHA PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3509
Mailing Address - Country:US
Mailing Address - Phone:815-570-9303
Mailing Address - Fax:866-950-9427
Practice Address - Street 1:1005 W LARAWAY RD STE 130
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2461
Practice Address - Country:US
Practice Address - Phone:815-570-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health