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NPI Code Detail

MEDICARE: MS. FREDERICA MELANIE MALONE MAAT, ATR, LCPC

MEDICARE: MS. FREDERICA MELANIE MALONE MAAT, ATR, LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180.006716IL

General Provider Information

NPI Number : 1639595580
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. FREDERICA MELANIE MALONE MAAT, ATR, LCPC
Provider Business Mailing Address
First Line : 2310 W ROOSEVELT RD
Second Line : SUITE 201
City : CHICAGO
State : IL
Zip : 60608-1131
Country : US
Telephone Number : 312-382-2504
Fax Number : 312-236-5384
Provider Business Practice Location Address
First Line : 2310 W ROOSEVELT RD
Second Line : SUITE 201
City : CHICAGO
State : IL
Zip : 60608-1131
Country : US
Telephone Number : 312-382-2504
Fax Number : 312-236-5384
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2014
Last Update Date : 08/19/2015

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