Provider Demographics
NPI:1205210895
Name:CONCEPCION, MARIA (MPA, MA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:MPA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 W GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5401
Mailing Address - Country:US
Mailing Address - Phone:773-803-9415
Mailing Address - Fax:
Practice Address - Street 1:4050 W GEORGE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-5401
Practice Address - Country:US
Practice Address - Phone:773-803-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter