Provider Demographics
NPI:1689112096
Name:PANDIT, ANJALI UMA (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:UMA
Last Name:PANDIT
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MARION ST
Mailing Address - Street 2:SUITE #313
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1167
Mailing Address - Country:US
Mailing Address - Phone:773-669-6549
Mailing Address - Fax:
Practice Address - Street 1:101 N MARION ST
Practice Address - Street 2:SUITE #313
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1167
Practice Address - Country:US
Practice Address - Phone:773-669-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical