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NPI Code Detail

MEDICARE: NEW MEXICO CENTER FOR FORENSIC PSYCHOLOGY PA

MEDICARE: NEW MEXICO CENTER FOR FORENSIC PSYCHOLOGY PA
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
1103TC0700XClinical Psychologist1139NM
2103TC0700XClinical Psychologist071008152IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11477861250OTHERILINDIVIDUAL NPI NUMBER

General Provider Information

NPI Number : 1447693668
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW MEXICO CENTER FOR FORENSIC PSYCHOLOGY PA
Provider Business Mailing Address
First Line : 5250 OLD ORCHARD RD STE 300
Second Line :
City : SKOKIE
State : IL
Zip : 60077-4462
Country : US
Telephone Number : 847-904-2299
Fax Number : 847-834-0087
Provider Business Practice Location Address
First Line : 5250 OLD ORCHARD RD STE 300
Second Line :
City : SKOKIE
State : IL
Zip : 60077-4462
Country : US
Telephone Number : 847-904-2299
Fax Number : 847-834-0087
Authorized Official
Title or Position : OWNER
Name : DR. ALEXANDER PARET
Credential : PH.D.
Telephone Number : 505-340-6440
Provider Enumeration Date : 04/08/2013
Last Update Date : 04/08/2013

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Directions to “NEW MEXICO CENTER FOR FORENSIC PSYCHOLOGY PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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