Provider Demographics
NPI:1043487549
Name:MICHELE MAURO, PSY.D., P.C.
Entity type:Organization
Organization Name:MICHELE MAURO, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-305-8876
Mailing Address - Street 1:3309 COOL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8240
Mailing Address - Country:US
Mailing Address - Phone:630-305-8876
Mailing Address - Fax:630-305-8876
Practice Address - Street 1:3309 COOL SPRINGS CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8240
Practice Address - Country:US
Practice Address - Phone:630-305-8876
Practice Address - Fax:630-305-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.005532251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212189Medicare PIN
IL212188Medicare PIN