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General NPI Number Information
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NPI Number | 1780936856
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Entity Type | Organization
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Legal Business Name | CHICAGO NEUROBEHAVIOR SPECIALISTS
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 15040 S RAVINIA AVE STE 49
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City | ORLAND PARK
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State | IL
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Zip | 60462-3173
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Country | US
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Telephone | 708-349-4420
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Fax | 708-349-4421
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Provider Business Mailing Address
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Address Line | 15040 S RAVINIA AVE STE 49
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City | ORLAND PARK
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State | IL
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Zip | 60462-3173
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Country | US
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Telephone | 708-349-4420
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Fax | 708-349-4421
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | HEATHER CASTILLO
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Credential |
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Telephone | 708-349-4420
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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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