MEDICARE: DR. THOMAS RYAN MAHER PSY.D

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
1	103TC0700X	Clinical Psychologist	071.022409	IL

General Provider Information

NPI Number	:	1922960558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RYAN MAHER PSY.D

Provider Business Mailing Address
First Line	:	3448 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-9740
Country	:	US
Telephone Number	:	773-245-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 N WOLCOTT AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6745
Country	:	US
Telephone Number	:	860-941-7168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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