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General NPI Number Information
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NPI Number | 1639258056
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Entity Type | Organization
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Legal Business Name | PSYCHODYNAMICS, P.C.
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 3118 N SHEFFIELD AVE UNIT 1-S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 847-604-4626
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 N SHEFFIELD AVE UNIT 1-S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 847-604-4626
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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. ALETA R. EDWARDS
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Credential | PSY.D.
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Telephone | 847-604-4626
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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 | 071004760
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License Number State | IL
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