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General NPI Number Information
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NPI Number | 1316015829
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Entity Type | Individual
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Provider Name | CATHY MOLLIE MAVROLAS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | E. 65TH AT LAKE MICHIGAN
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City | CHICAGO
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State | IL
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Zip | 60649
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Country | US
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Telephone | 773-256-5722
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Fax | 773-363-7664
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Provider Business Mailing Address
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Address Line | 1591 N KING GEORGE CT
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City | PALATINE
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State | IL
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Zip | 60067-2764
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Country | US
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Telephone | 847-359-0589
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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