Provider Demographics
NPI:1932603578
Name:MAVALANKAR, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MAVALANKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W BROMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7147
Mailing Address - Country:US
Mailing Address - Phone:773-391-3091
Mailing Address - Fax:
Practice Address - Street 1:521 W BROMPTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7147
Practice Address - Country:US
Practice Address - Phone:773-391-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical