| Blackbird Behavioral Health | |
|
715 Lake St Ste 410 Oak Park IL 60301-1413 | |
| (708) 209-8987 | |
| Not Available |
| Full Name | Blackbird Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 715 Lake St Ste 410, Oak Park, Illinois |
| Authorized Official Name and Position | Sharon K Black (DIRECTOR) |
| Authorized Official Contact | 7082098987 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackbird Behavioral Health 633 Carpenter Ave Oak Park IL 60304-1104 Ph: (708) 209-8987 | Blackbird Behavioral Health 715 Lake St Ste 410 Oak Park IL 60301-1413 Ph: (708) 209-8987 |
| NPI Number | 1245748722 |
|---|---|
| Provider Enumeration Date | 01/18/2018 |
| Last Update Date | 03/26/2018 |
| Medicare PECOS PAC ID | 4284998212 |
|---|---|
| Medicare Enrollment ID | O20180427001868 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245748722 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Frank Czuba |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174854707 PECOS PAC ID: 0749250819 Enrollment ID: I20040727001009 |
| Provider Name | Linda Kay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922368497 PECOS PAC ID: 7214231414 Enrollment ID: I20160209001302 |
| Provider Name | Sharon K Black |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407094915 PECOS PAC ID: 0749228922 Enrollment ID: I20180427001969 |
| Provider Name | Candida Jacoby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164939872 PECOS PAC ID: 8022352004 Enrollment ID: I20181203000049 |
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