Provider Demographics
NPI:1447904412
Name:DR LUIS C MAYOLO INC
Entity type:Organization
Organization Name:DR LUIS C MAYOLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-910-5381
Mailing Address - Street 1:832 PLAINFIELD NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6414
Mailing Address - Country:US
Mailing Address - Phone:248-910-5381
Mailing Address - Fax:
Practice Address - Street 1:832 PLAINFIELD NAPERVILLE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6414
Practice Address - Country:US
Practice Address - Phone:248-910-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty