Healthcare Provider Details

I. General information

NPI: 1619101961
Provider Name (Legal Business Name): HEATHER WALDMAN CINTRON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W OGDEN AVE 5TH FLOOR
CHICAGO IL
60612
US

IV. Provider business mailing address

1920 S HIGHLAND AVE STE 300
LOMBARD IL
60148-6149
US

V. Phone/Fax

Practice location:
  • Phone: 312-433-5329
  • Fax: 312-433-6851
Mailing address:
  • Phone: 773-603-0667
  • Fax: 630-576-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: