Provider Demographics
NPI:1689277576
Name:MAITRI PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MAITRI PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIPALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARADWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-272-4808
Mailing Address - Street 1:3320 W FOSTER AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3320 W FOSTER AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4813
Practice Address - Country:US
Practice Address - Phone:630-272-4808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)