Provider Demographics
NPI:1023433489
Name:HALPERIN, MARYLU (RN, LCPC)
Entity type:Individual
Prefix:
First Name:MARYLU
Middle Name:
Last Name:HALPERIN
Suffix:
Gender:F
Credentials:RN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 MUSKEGAN CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3418
Mailing Address - Country:US
Mailing Address - Phone:847-650-5201
Mailing Address - Fax:
Practice Address - Street 1:1033 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3196
Practice Address - Country:US
Practice Address - Phone:847-650-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009006101YM0800X
IL180.009006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health