MEDICARE: CENTER FOR APPLIED PSYCHOLOGY AND FORENSIC STUDIES

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		IL

General Provider Information

NPI Number	:	1386821551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR APPLIED PSYCHOLOGY AND FORENSIC STUDIES

Provider Business Mailing Address
First Line	:	205 W RANDOLPH ST STE 830
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1815
Country	:	US
Telephone Number	:	312-236-1498
Fax Number	:	312-236-0537

Provider Business Practice Location Address
First Line	:	205 W RANDOLPH ST STE 830
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1815
Country	:	US
Telephone Number	:	312-236-1498
Fax Number	:	312-236-0537

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. CONSTANCE ANITA FULLILOVE
Credential	:	PH.D.
Telephone Number	:	312-236-1498

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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