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General NPI Number Information
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NPI Number | 1588998678
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Entity Type | Organization
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Legal Business Name | ASSOCIATES FOR EDUCATIONAL AND PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1701 E LAKE AVE SUITE 165
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City | GLENVIEW
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State | IL
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Zip | 60025-2065
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Country | US
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Telephone | 847-924-3951
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Fax | 847-998-6499
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Provider Business Mailing Address
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Address Line | 1701 E LAKE AVE SUITE 165
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City | GLENVIEW
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State | IL
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Zip | 60025-2065
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Country | US
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Telephone | 847-924-3951
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CHARLES NICHOLAS PISTORIO
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Credential | PH.D.
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Telephone | 847-924-3951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004038
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License Number State | IL
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