Provider Demographics
NPI:1184810186
Name:CHAWLA, NITAYA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NITAYA
Middle Name:
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1757
Mailing Address - Country:US
Mailing Address - Phone:630-479-9752
Mailing Address - Fax:630-323-9757
Practice Address - Street 1:850 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3077
Practice Address - Country:US
Practice Address - Phone:773-975-6721
Practice Address - Fax:630-323-9757
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008316103TC0700X
IL18000541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional