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General NPI Number Information
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NPI Number | 1356792477
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Entity Type | Organization
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Legal Business Name | REN F DUARTE PSY D INC
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 3200 N LAKE SHORE DR APT. 1001
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City | CHICAGO
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State | IL
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Zip | 60657-3952
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Country | US
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Telephone | 773-315-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 N LAKE SHORE DR APT. 1001
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City | CHICAGO
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State | IL
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Zip | 60657-3952
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Country | US
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Telephone | 773-315-0636
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | REN F DUARTE
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Credential | PSY . D.
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Telephone | 773-315-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 071-006715
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License Number State | IL
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