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General NPI Number Information
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NPI Number | 1578231676
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Entity Type | Organization
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Legal Business Name | ADVANCED PSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE STE 310
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City | CHICAGO
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State | IL
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Zip | 60657-5084
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Country | US
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Telephone | 773-234-0695
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 N PINE GROVE AVE APT 1911
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City | CHICAGO
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State | IL
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Zip | 60613-5510
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Country | US
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Telephone | 609-221-4863
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LESLIE CREA-KAMMERER
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Credential | PSYD
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Telephone | 96-221-4863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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