Provider Demographics
NPI:1013328046
Name:GUPTA, GARIMAA RESHMA (BSC)
Entity Type:Individual
Prefix:
First Name:GARIMAA
Middle Name:RESHMA
Last Name:GUPTA
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 BENNETT PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7069
Mailing Address - Country:US
Mailing Address - Phone:331-444-2888
Mailing Address - Fax:
Practice Address - Street 1:1001 ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3217
Practice Address - Country:US
Practice Address - Phone:847-524-8800
Practice Address - Fax:847-524-8824
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201209251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health