Healthcare Provider Details

I. General information

NPI: 1649539560
Provider Name (Legal Business Name): LIANA GERDOV PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 W NORTHWEST HWY
PALATINE IL
60067-1897
US

IV. Provider business mailing address

402 WENTWORTH CIR
CARY IL
60013-2321
US

V. Phone/Fax

Practice location:
  • Phone: 773-592-7227
  • Fax: 630-216-1126
Mailing address:
  • Phone: 630-988-5364
  • Fax: 630-216-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: