Provider Demographics
NPI:1902113871
Name:VAISAITE, DALIA (LMFT)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:VAISAITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3024
Mailing Address - Country:US
Mailing Address - Phone:847-906-3005
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE STE 220
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3024
Practice Address - Country:US
Practice Address - Phone:847-906-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA106421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist