Provider Demographics
NPI:1164742292
Name:LAIRD, RITAMARIA SHULAMITH
Entity Type:Individual
Prefix:MISS
First Name:RITAMARIA
Middle Name:SHULAMITH
Last Name:LAIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 S CICERO AVE
Mailing Address - Street 2:208
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5400
Mailing Address - Country:US
Mailing Address - Phone:708-576-4027
Mailing Address - Fax:708-424-1394
Practice Address - Street 1:10735 S CICERO AVE
Practice Address - Street 2:208
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5400
Practice Address - Country:US
Practice Address - Phone:708-424-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health