Provider Demographics
NPI:1912759259
Name:CHARATZ, MALLORY
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:CHARATZ
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 1:138 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-8976
Mailing Address - Country:US
Mailing Address - Phone:224-875-9965
Mailing Address - Fax:
Practice Address - Street 1:1300 REMINGTON RD STE K
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4800
Practice Address - Country:US
Practice Address - Phone:847-496-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician