Provider Demographics
NPI:1093896169
Name:TRIVEDI-PUROHIT, RITU D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:D
Last Name:TRIVEDI-PUROHIT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 IVORY LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1230
Mailing Address - Country:US
Mailing Address - Phone:847-742-6041
Mailing Address - Fax:866-565-9307
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-742-6041
Practice Address - Fax:866-565-9307
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical