Provider Demographics
NPI:1285418871
Name:PANDYA, ROOPALI GHOSH (LCPC, CCM)
Entity type:Individual
Prefix:
First Name:ROOPALI
Middle Name:GHOSH
Last Name:PANDYA
Suffix:
Gender:F
Credentials:LCPC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 N SANGAMON ST APT 5S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6078
Mailing Address - Country:US
Mailing Address - Phone:434-825-8114
Mailing Address - Fax:
Practice Address - Street 1:663 N SANGAMON ST APT 5S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6078
Practice Address - Country:US
Practice Address - Phone:434-825-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health