MEDICARE: AFFILIATED PSYCHOLOGISTS LTD

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16145677	OTHER	IL	BLUECROSS BLUESHIELD ID

General Provider Information

NPI Number	:	1760516447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED PSYCHOLOGISTS LTD

Provider Business Mailing Address
First Line	:	4801 W PETERSON AVE STE 525
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5731
Country	:	US
Telephone Number	:	773-286-3100
Fax Number	:	773-777-7543

Provider Business Practice Location Address
First Line	:	4801 W PETERSON AVE STE 525
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5731
Country	:	US
Telephone Number	:	773-286-3100
Fax Number	:	773-777-7543

Authorized Official
Title or Position	:	CLINICAL SERVICE COORDINATOR
Name	:	KASIA MALINGER
Credential	:
Telephone Number	:	773-286-3100

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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