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General NPI Number Information
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NPI Number | 1760367163
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Entity Type | Organization
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Legal Business Name | INTERCONNECTIVITY PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2731 W PRINDIVILLE ST
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City | CHICAGO
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State | IL
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Zip | 60647-4028
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Country | US
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Telephone | 224-639-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 W DIVISION ST # 187
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City | CHICAGO
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State | IL
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Zip | 60622-9024
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Country | US
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Telephone | 224-639-2368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXA KERAMIDAS
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Credential |
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Telephone | 224-639-2368
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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 |
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License Number State |
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