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General NPI Number Information
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NPI Number | 1063829174
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Entity Type | Organization
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Legal Business Name | NEW LEAF PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/27/2014
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Provider Practice Location Address
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Address Line | 2172 TECHNY RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-6635
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Country | US
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Telephone | 773-960-1163
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Fax | 224-415-3911
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Provider Business Mailing Address
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Address Line | 2172 TECHNY RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-6635
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Country | US
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Telephone | 773-960-1163
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Fax | 224-415-3911
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | DR. CHRISTINA IRMGARD ALEXAKOS
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Credential | PSY.D.
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Telephone | 773-960-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008103
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License Number State | IL
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