| Department Of Psychiatry | |
|
912 S Wood St Chicago IL 60612-4300 | |
| (312) 413-3783 | |
| (312) 996-3514 |
| Full Name | Department Of Psychiatry |
|---|---|
| Speciality | Clinic/Center |
| Location | 912 S Wood St, Chicago, Illinois |
| Authorized Official Name and Position | Sunita Prabhakar (DIRECTOR OF PHYSICIAN PRACTICE) |
| Authorized Official Contact | 3124133783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Department Of Psychiatry 7825 Solution Center Chicago IL 60677-7008 Ph: (312) 996-7383 | Department Of Psychiatry 912 S Wood St Chicago IL 60612-4300 Ph: (312) 413-3783 |
| NPI Number | 1609822147 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 12/07/2015 |
| Medicare PECOS PAC ID | 3072422716 |
|---|---|
| Medicare Enrollment ID | O20031126000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609822147 | NPI | - | NPPES |
| 203465 | Other | IL | MEDICARE APN/CNS |
| 01618662 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Joseph L Mastro |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346212461 PECOS PAC ID: 9133187222 Enrollment ID: I20041221000407 |
| Provider Name | Colleen M Reese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104987148 PECOS PAC ID: 7416920475 Enrollment ID: I20100201000139 |
| Provider Name | John W Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679672653 PECOS PAC ID: 1658566757 Enrollment ID: I20101115001204 |
| Provider Name | Beatrice T Naulleau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013015346 PECOS PAC ID: 7214109230 Enrollment ID: I20111017000139 |
| Provider Name | Stockton M Mayer |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1114193240 PECOS PAC ID: 7416197116 Enrollment ID: I20130701000057 |
| Provider Name | Denika S Mcmillen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174930077 PECOS PAC ID: 9335365147 Enrollment ID: I20140730001741 |
| Provider Name | Maricarmen Herrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982005203 PECOS PAC ID: 6800118290 Enrollment ID: I20141215001998 |
| Provider Name | Kristina Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255734869 PECOS PAC ID: 6901120468 Enrollment ID: I20150112000876 |
| Provider Name | Dorothy C Tessman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639567886 PECOS PAC ID: 1850619602 Enrollment ID: I20150408000364 |
| Provider Name | Jesse D Herron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841706371 PECOS PAC ID: 2567724404 Enrollment ID: I20180313000887 |
| Provider Name | Julie A Carbray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639261837 PECOS PAC ID: 2668721598 Enrollment ID: I20180824002884 |
| Provider Name | Maria Siena H May |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760018733 PECOS PAC ID: 2062832033 Enrollment ID: I20201013000311 |
| Provider Name | Osasumwen O Igbinoba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942833306 PECOS PAC ID: 9032536438 Enrollment ID: I20201212000014 |
| Provider Name | Nicholas Dotson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497946693 PECOS PAC ID: 0143625863 Enrollment ID: I20210818003367 |
| Provider Name | Kelsey Nicole Christensen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124764543 PECOS PAC ID: 7618344318 Enrollment ID: I20221109003138 |
| Provider Name | Deepa Shrestha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962190223 PECOS PAC ID: 5799137667 Enrollment ID: I20240116002798 |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |