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General NPI Number Information
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NPI Number | 1669092359
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Entity Type | Individual
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Provider Name | MAYRA YADIRA ISIDORO
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Gender | Female
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 58 E CLINTON ST
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City | JOLIET
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State | IL
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Zip | 60432-4143
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Country | US
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Telephone | 815-723-0331
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Fax |
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Provider Business Mailing Address
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Address Line | 177 S VILLA AVE
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City | ELMHURST
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State | IL
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Zip | 60126-3030
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Country | US
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Telephone | 630-843-2149
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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