Provider Demographics
NPI:1922372077
Name:MAJMUDAR, MEERABEN (PSYD)
Entity Type:Individual
Prefix:
First Name:MEERABEN
Middle Name:
Last Name:MAJMUDAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MEERABEN
Other - Middle Name:
Other - Last Name:VAGHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:19 E SANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177
Mailing Address - Country:US
Mailing Address - Phone:630-923-5421
Mailing Address - Fax:
Practice Address - Street 1:2425 ROYAL BLVD
Practice Address - Street 2:STE 2
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2507
Practice Address - Country:US
Practice Address - Phone:630-605-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical