Provider Demographics
NPI:1972134161
Name:BARANIAK, MONIKA
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:BARANIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:MITROSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5725 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2607
Mailing Address - Country:US
Mailing Address - Phone:708-705-7180
Mailing Address - Fax:
Practice Address - Street 1:5501 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1784
Practice Address - Country:US
Practice Address - Phone:708-296-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional