Healthcare Provider Details

I. General information

NPI: 1326318742
Provider Name (Legal Business Name): ELIZABETH ANNE MALOY-MATUZIK PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 WALDEN OFFICE SQ STE 510
SCHAUMBURG IL
60173-4278
US

IV. Provider business mailing address

894 NELLI CT 202
NAPERVILLE IL
60563-4204
US

V. Phone/Fax

Practice location:
  • Phone: 708-822-8623
  • Fax:
Mailing address:
  • Phone: 708-822-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: