MEDICARE: DR. CHARLES E BEHRENS PSY.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	103TC0700X	Clinical Psychologist	071005216	IL

General Provider Information

NPI Number	:	1740492628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E BEHRENS PSY.D.

Provider Business Mailing Address
First Line	:	7636 N NEVA AVE
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-4746
Country	:	US
Telephone Number	:	847-696-9223
Fax Number	:	847-696-9255

Provider Business Practice Location Address
First Line	:	5547 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1125
Country	:	US
Telephone Number	:	773-769-4313
Fax Number	:	773-769-1179

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/29/2015

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