Provider Demographics
NPI:1467698167
Name:CORNEJO GARCIA, MARIA ALICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALICIA
Last Name:CORNEJO GARCIA
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 1:2100 MANCHESTER RD STE 921
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4649
Mailing Address - Country:US
Mailing Address - Phone:630-296-9126
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 921
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4649
Practice Address - Country:US
Practice Address - Phone:630-296-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical