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General NPI Number Information
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NPI Number | 1578835682
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Entity Type | Organization
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Legal Business Name | T. KACMARCIK, LTD
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 02/04/2012
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Provider Practice Location Address
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Address Line | 132 N WASHINGTON ST SUITE 2A
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City | NAPERVILLE
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State | IL
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Zip | 60540-4512
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Country | US
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Telephone | 630-428-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 631 BEAVER CT
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City | NAPERVILLE
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State | IL
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Zip | 60563-9784
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Country | US
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Telephone |
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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. TARA A KACMARCIK
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Credential | PSYD
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Telephone | 847-989-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071006499
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License Number State | IL
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