MEDICARE: CONSULTANTS FOR ORGANIZATION&PERSONAL ENRICHMENT, P.C.

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	103T00000X	Psychologist	71-836	IL

General Provider Information

NPI Number	:	1366610552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS FOR ORGANIZATION&PERSONAL ENRICHMENT, P.C.

Provider Business Mailing Address
First Line	:	16 FORSYTHIA CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-5643
Country	:	US
Telephone Number	:	919-489-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 E RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4356
Country	:	US
Telephone Number	:	847-259-3556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY PERLMUTTER
Credential	:	PH.D.
Telephone Number	:	919-489-3200

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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