Healthcare Provider Details

I. General information

NPI: 1366354953
Provider Name (Legal Business Name): PASARICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E ERIE ST APT 2712
CHICAGO IL
60611-6211
US

IV. Provider business mailing address

2 E ERIE ST APT 2712
CHICAGO IL
60611-6211
US

V. Phone/Fax

Practice location:
  • Phone: 708-657-5043
  • Fax:
Mailing address:
  • Phone: 708-657-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DERRICK JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 708-657-5043