| Charles Pistorio Ltd | |
|
1701 E Lake Ave Ste 376 Glenview IL 60025-2065 | |
| (847) 924-3951 | |
| (847) 998-6499 |
| Full Name | Charles Pistorio Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 1701 E Lake Ave Ste 376, Glenview, Illinois |
| Authorized Official Name and Position | Charles N Pistorio (OWNER) |
| Authorized Official Contact | 8479243951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Pistorio Ltd 1701 E Lake Ave Ste 376 Glenview IL 60025-2065 Ph: (847) 924-3951 | Charles Pistorio Ltd 1701 E Lake Ave Ste 376 Glenview IL 60025-2065 Ph: (847) 924-3951 |
| NPI Number | 1508542655 |
|---|---|
| Provider Enumeration Date | 06/23/2023 |
| Last Update Date | 06/23/2023 |
| Certification Date | 06/23/2023 |
| Medicare PECOS PAC ID | 0345696886 |
|---|---|
| Medicare Enrollment ID | O20231019002702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508542655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Charles Nicholas Pistorio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922253848 PECOS PAC ID: 1254787799 Enrollment ID: I20231019002792 |
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