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General NPI Number Information
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NPI Number | 1750824496
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PSYCHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1333 W BELMONT AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-5785
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Country | US
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Telephone | 847-686-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SKOKIE BLVD SUITE 245
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City | NORTHBROOK
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State | IL
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Zip | 60062-2816
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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 | BUSINESS MANAGER
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Name | ADAM KREDOW
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Credential |
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Telephone | 847-686-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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