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General NPI Number Information
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NPI Number | 1578714499
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Entity Type | Organization
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Legal Business Name | PSYCHOEDUCATIONAL RESOURCE SERVICES
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 5225 OLD ORCHARD RD 26A
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City | SKOKIE
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State | IL
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Zip | 60077-4405
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Country | US
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Telephone | 847-508-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 OLD ORCHARD RD 26A
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City | SKOKIE
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State | IL
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Zip | 60077-4405
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Country | US
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Telephone | 847-508-7846
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PSYCHOLOGIST
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Name | DR. PETER B. RASTRELLI
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Credential | ED.D.
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Telephone | 847-508-7846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1691243
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1683662
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License Number State | IL
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