Provider Demographics
NPI:1861557498
Name:STEIN, MARA TESLER (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARA
Middle Name:TESLER
Last Name:STEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 N CICERO AVE
Mailing Address - Street 2:AUITE 203
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2112
Mailing Address - Country:US
Mailing Address - Phone:773-338-2980
Mailing Address - Fax:
Practice Address - Street 1:7101 N CICERO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2112
Practice Address - Country:US
Practice Address - Phone:773-338-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical