1790954998 NPI number — PERLMAN DAVIS AND ASSOCIATES IN PSYCHOLOGY

Table of content: (NPI 1790954998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790954998 NPI number — PERLMAN DAVIS AND ASSOCIATES IN PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERLMAN DAVIS AND ASSOCIATES IN PSYCHOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790954998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 HALF DAY RD
Provider Second Line Business Mailing Address:
SUITE 145
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-236-1574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 HALF DAY RD
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-236-1574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERLMAN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
847-236-1574

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  71-3882 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0004972072 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4509988 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 163550 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".