Healthcare Provider Details

I. General information

NPI: 1922323260
Provider Name (Legal Business Name): KRISTINA M PECORA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MICHIGAN AVE STE 1520
CHICAGO IL
60611-3758
US

IV. Provider business mailing address

1812 S DEARBORN ST APT 30
CHICAGO IL
60616-1688
US

V. Phone/Fax

Practice location:
  • Phone: 312-498-1166
  • Fax:
Mailing address:
  • Phone: 312-498-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071007823
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: