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General NPI Number Information
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NPI Number | 1518131002
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHIATRIC SERVICES SC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1044 N FRANCISCO AVE STE 403
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City | CHICAGO
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State | IL
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Zip | 60622-2743
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Country | US
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Telephone | 847-212-9809
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 S PRAIRIE AVE SUITE 5505
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City | CHICAGO
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State | IL
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Zip | 60605-3645
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Country | US
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Telephone | 847-212-9809
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACINTO ANTONIO V DIZON
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Credential | M.D.
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Telephone | 847-212-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036085219
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License Number State | IL
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