Healthcare Provider Details

I. General information

NPI: 1730372293
Provider Name (Legal Business Name): MARY BETH VERBINSKI CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S 5TH AVE 11K
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2321
  • Fax:
Mailing address:
  • Phone: 708-202-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: