MEDICARE: DR. KEVIN JOSEPH VAN ERON PSY.D., LCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-007046	IL

General Provider Information

NPI Number	:	1356408454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JOSEPH VAN ERON PSY.D., LCP

Provider Business Mailing Address
First Line	:	53 W JACKSON BLVD
Second Line	:	SUITE 1111
City	:	CHICAGO
State	:	IL
Zip	:	60604-3606
Country	:	US
Telephone Number	:	312-593-6791
Fax Number	:	312-356-9961

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD
Second Line	:	SUITE 1111
City	:	CHICAGO
State	:	IL
Zip	:	60604-3606
Country	:	US
Telephone Number	:	312-593-6791
Fax Number	:	312-356-9961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/19/2012

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