Provider Demographics
NPI:1356337612
Name:RAMIREZ, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 BAY SCOTT CIR STE 109
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1130
Mailing Address - Country:US
Mailing Address - Phone:630-357-2456
Mailing Address - Fax:630-357-2482
Practice Address - Street 1:1819 BAY SCOTT CIR
Practice Address - Street 2:STE. 109
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1129
Practice Address - Country:US
Practice Address - Phone:630-357-2456
Practice Address - Fax:630-357-2482
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000241101YP2500X
IL166-000890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36-2846570OtherSAMARITAN INTERFAITH COUNSELING