Healthcare Provider Details

I. General information

NPI: 1730328832
Provider Name (Legal Business Name): GERIATRIC PSYCHIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTBROOK CORPORATE CTR SUITE 300
WESTCHESTER IL
60154-5701
US

IV. Provider business mailing address

28800 RYAN RD SUITE 320
WARREN MI
48092-4272
US

V. Phone/Fax

Practice location:
  • Phone: 708-375-3075
  • Fax: 866-227-7418
Mailing address:
  • Phone: 586-620-8100
  • Fax: 866-227-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT A CLEMENTE
Title or Position: ADMIN DIR.
Credential: ESQ.
Phone: 586-620-8100