MEDICARE: DR. ROSARIO C. PESCE PH.D.

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		IL

General Provider Information

NPI Number	:	1598854630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSARIO C. PESCE PH.D.

Provider Business Mailing Address
First Line	:	3218 N PANAMA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2919
Country	:	US
Telephone Number	:	773-625-9112
Fax Number	:	773-625-8648

Provider Business Practice Location Address
First Line	:	7151 W GUNNISON
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706
Country	:	US
Telephone Number	:	312-316-3754
Fax Number	:	773-625-8648

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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