| Child Psychiatric Services, Ltd. | |
|
495 Central Ave Suite 203 Northfield IL 60093-3044 | |
| (847) 251-1046 | |
| (847) 789-7172 |
| Full Name | Child Psychiatric Services, Ltd. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 495 Central Ave, Northfield, Illinois |
| Authorized Official Name and Position | Alexander Kek (ADMINISTRATOR) |
| Authorized Official Contact | 8472511046 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Child Psychiatric Services, Ltd. Po Box 82 Kenilworth IL 60043-0082 Ph: (847) 251-1046 | Child Psychiatric Services, Ltd. 495 Central Ave Suite 203 Northfield IL 60093-3044 Ph: (847) 251-1046 |
| NPI Number | 1386818011 |
|---|---|
| Provider Enumeration Date | 04/14/2008 |
| Last Update Date | 12/30/2014 |
| Medicare PECOS PAC ID | 4183651862 |
|---|---|
| Medicare Enrollment ID | O20050725000688 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386818011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 036-108993 (Illinois) | Primary |
| Provider Name | Anna Ivanenko |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255308334 PECOS PAC ID: 8224008438 Enrollment ID: I20040727000513 |
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