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General NPI Number Information
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NPI Number | 1326161530
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Entity Type | Organization
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Legal Business Name | DEBORAH A CZUPEK
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5757 W 95TH ST STE 9
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City | OAK LAWN
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State | IL
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Zip | 60453-2370
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Country | US
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Telephone | 708-425-4797
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Fax |
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Provider Business Mailing Address
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Address Line | 5757 W 95TH ST STE 9
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City | OAK LAWN
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State | IL
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Zip | 60453-2370
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Country | US
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Telephone | 708-425-4797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBORAH ANNE CZUPEK
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Credential | PH.D.
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Telephone | 708-425-4797
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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 |
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License Number State | IL
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