MEDICARE: TIA MARINA GEORGIADES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1174486088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA MARINA GEORGIADES

Provider Business Mailing Address
First Line	:	900 WAUKEGAN RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-4315
Country	:	US
Telephone Number	:	331-229-8839
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WAUKEGAN RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-4315
Country	:	US
Telephone Number	:	331-229-8839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	05/18/2026

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Directions to “ TIA MARINA GEORGIADES ” Practice Location

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