Active NPI
Maria Lago, DT
- Developmental Therapist
- Berwyn, IL
National Provider Identifier
1235341694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- ML31740803P
- Practice address
- 3146 Maple Ave
Berwyn, IL 60402-2851 - Phone
- (708) 308-8351
- Fax
- (708) 484-8409
- NPI assigned
- May 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | ML31740803P | IL | Primary |
Addresses
Primary practice location
3146 Maple Ave
Berwyn, IL 60402-2851
Mailing address
3146 Maple Ave
Berwyn, IL 60402-2851
Phone (708) 484-8361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ML31740803P | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185148800000",
"number": "1235341694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3146 MAPLE AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022851",
"telephone_number": "708-484-8361",
"fax_number": "708-484-8409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3146 MAPLE AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022851",
"telephone_number": "708-308-8351",
"fax_number": "708-484-8409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAGO",
"first_name": "MARIA",
"credential": "DT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-05",
"last_updated": "2007-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "ML31740803P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.