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General NPI Number Information
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NPI Number | 1457891764
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEUROPSYCHOLOGY SERVICES
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE SUITE 13
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 312-669-4874
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Fax |
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Provider Business Mailing Address
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Address Line | 856 W BUCKINGHAM PL 1W
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City | CHICAGO
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State | IL
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Zip | 60657-2383
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Country | US
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Telephone | 312-669-4874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW WILLIAM HEFFERON
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Credential |
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Telephone | 312-669-4874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 071-008309
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License Number State | IL
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