Individual
DR. MARY ELIZABETH PAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1526 W OHIO ST, CHICAGO, IL 60642-6102
(312) 455-0224
Mailing address
1526 W OHIO ST, CHICAGO, IL 60642-6102
(312) 455-0224
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-001694
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1672549
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
07/17/2005
Last updated
09/21/2011
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