Healthcare Provider Details

I. General information

NPI: 1053228700
Provider Name (Legal Business Name): JOSSELYN MAYA MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSSELYN MAYA LEON

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S ARDMORE AVE
VILLA PARK IL
60181-2614
US

IV. Provider business mailing address

630 S MONTEREY AVE
VILLA PARK IL
60181-3026
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-4060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.131044
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: