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825 W State St Ste 103d Geneva IL 60134-2078 | |
| (331) 223-0330 | |
| (630) 528-0775 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 825 W State St Ste 103d, Geneva, Illinois |
| Authorized Official Name and Position | Maryann Dematthews (SOLE OWNER, ADMINISTRATOR) |
| Authorized Official Contact | 3312230330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
825 W State St Ste 103d Geneva IL 60134-2078 Ph: () - | 825 W State St Ste 103d Geneva IL 60134-2078 Ph: (331) 223-0330 |
| NPI Number | 1811533318 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 6002352598 |
|---|---|
| Medicare Enrollment ID | O20240719003053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811533318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Maryann Dematthews |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720402845 PECOS PAC ID: 9638615123 Enrollment ID: I20240719003111 |
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