Provider Demographics
NPI:1346628252
Name:VASSILEVA, MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:VASSILEVA
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 1:1619 W COLONIAL PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4732
Mailing Address - Country:US
Mailing Address - Phone:312-536-0807
Mailing Address - Fax:
Practice Address - Street 1:1619 W COLONIAL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4732
Practice Address - Country:US
Practice Address - Phone:312-536-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009581103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical