Provider Demographics
NPI:1295348506
Name:AMAOLI LLC
Entity type:Organization
Organization Name:AMAOLI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:331-442-6551
Mailing Address - Street 1:164 DIVISION ST STE 617
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5533
Mailing Address - Country:US
Mailing Address - Phone:331-442-6551
Mailing Address - Fax:
Practice Address - Street 1:164 DIVISION ST STE 617
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5533
Practice Address - Country:US
Practice Address - Phone:331-442-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty