Provider Demographics
NPI:1033628524
Name:CABY, MELISSA (EDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CABY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SOUTHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1633
Mailing Address - Country:US
Mailing Address - Phone:312-623-2956
Mailing Address - Fax:
Practice Address - Street 1:86 SOUTHCOTE RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1633
Practice Address - Country:US
Practice Address - Phone:312-623-2956
Practice Address - Fax:312-623-2956
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL887470103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool