Healthcare Provider Details

I. General information

NPI: 1437334281
Provider Name (Legal Business Name): PIA I TODRAS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 REVERE DR
NORTHBROOK IL
60062-1564
US

IV. Provider business mailing address

255 REVERE DR
NORTHBROOK IL
60062-1564
US

V. Phone/Fax

Practice location:
  • Phone: 847-412-4350
  • Fax:
Mailing address:
  • Phone: 847-412-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178-005264
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-007800
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: