MEDICARE: REN F DUARTE 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	103T00000X	Psychologist	071-006715	IL

General Provider Information

NPI Number	:	1902935208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REN F DUARTE PSY.D.

Provider Business Mailing Address
First Line	:	3200 N LAKE SHORE DR
Second Line	:	APT. 1001
City	:	CHICAGO
State	:	IL
Zip	:	60657-3952
Country	:	US
Telephone Number	:	773-348-9960
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N LAKE SHORE DR
Second Line	:	APT. 1001
City	:	CHICAGO
State	:	IL
Zip	:	60657-1944
Country	:	US
Telephone Number	:	773-348-9960
Fax Number	:

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	06/07/2016

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