Provider Demographics
NPI:1063512036
Name:MALING, MICHAEL S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:MALING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4721
Mailing Address - Country:US
Mailing Address - Phone:800-508-2200
Mailing Address - Fax:847-945-0853
Practice Address - Street 1:660 LASALLE PLACE
Practice Address - Street 2:SUITE 1A
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-780-4900
Practice Address - Fax:847-945-0853
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical