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General NPI Number Information
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NPI Number | 1003950262
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Entity Type | Individual
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Provider Name | MERISSA MALACARA PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 407
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City | CHICAGO
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State | IL
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Zip | 60657-3242
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Country | US
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Telephone | 773-234-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 2226 W FLETCHER ST
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City | CHICAGO
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State | IL
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Zip | 60618-6404
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Country | US
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Telephone | 262-939-1834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008574
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License Number State | IL
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