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NPI Code Detail

MEDICARE: CENTER FOR INTEGRATIVE PSYCHIATRY LLC

MEDICARE: CENTER FOR INTEGRATIVE PSYCHIATRY LLC
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1477011310
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR INTEGRATIVE PSYCHIATRY LLC
Provider Business Mailing Address
First Line : 8745 W HIGGINS RD STE 110
Second Line :
City : CHICAGO
State : IL
Zip : 60631-2753
Country : US
Telephone Number : 224-361-3301
Fax Number : 405-337-9658
Provider Business Practice Location Address
First Line : 8745 W HIGGINS RD STE 110
Second Line :
City : CHICAGO
State : IL
Zip : 60631-2753
Country : US
Telephone Number : 224-361-3301
Fax Number : 405-337-9658
Authorized Official
Title or Position : OWNER
Name : DR. BERNADETTE MIETUS STEVENSON
Credential : MD, PHD
Telephone Number : 224-361-3301
Provider Enumeration Date : 03/11/2019
Last Update Date : 04/23/2023

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Directions to “CENTER FOR INTEGRATIVE PSYCHIATRY LLC ” Practice Location

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