Provider Demographics
NPI:1053198580
Name:MA, YATMING CASSANDRA (PSYD)
Entity type:Individual
Prefix:
First Name:YATMING
Middle Name:CASSANDRA
Last Name:MA
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 1:2200 S MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5366
Mailing Address - Country:US
Mailing Address - Phone:630-209-4554
Mailing Address - Fax:
Practice Address - Street 1:2200 S MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5364
Practice Address - Country:US
Practice Address - Phone:630-209-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005296103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent