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General NPI Number Information
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NPI Number | 1356959332
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Entity Type | Individual
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Provider Name | NIKHITA MOOLAYIL
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Gender | Female
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2715 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1351
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Country | US
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Telephone | 773-360-1389
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Fax |
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Provider Business Mailing Address
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Address Line | 2715 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1351
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071011200
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License Number State | IL
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