Provider Demographics
NPI:1336478809
Name:TIRADO, AIDALUZ (PSYD)
Entity Type:Individual
Prefix:
First Name:AIDALUZ
Middle Name:
Last Name:TIRADO
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 1:3431 N OAKLEY AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6009
Mailing Address - Country:US
Mailing Address - Phone:561-322-5032
Mailing Address - Fax:
Practice Address - Street 1:1320 TOWER RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4309
Practice Address - Country:US
Practice Address - Phone:847-598-3553
Practice Address - Fax:847-598-3554
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical