MEDICARE: CENTRAL DUPAGE BEHAVIORAL HEALTH, 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
1	251S00000X	Community/Behavioral Health Agency
2	103T00000X	Psychologist	071008873	IL

General Provider Information

NPI Number	:	1730580358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL DUPAGE BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	4580 WEAVER PKWY STE 204
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3864
Country	:	US
Telephone Number	:	630-604-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 WEAVER PKWY STE 204
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3864
Country	:	US
Telephone Number	:	630-604-5000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KUNAL SACHDEV
Credential	:	PSY.D.
Telephone Number	:	630-604-5000

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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