| Drlullaby Llc | |
|
400 W Ontario Street #512 Chicago IL 60654 | |
| (224) 572-8470 | |
| Not Available |
| Full Name | Drlullaby Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 W Ontario Street, Chicago, Illinois |
| Authorized Official Name and Position | Lisa Medalie (CEO) |
| Authorized Official Contact | 2245728470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drlullaby Llc 1440 W Taylor St # 556 Chicago IL 60607-4623 Ph: (619) 997-5759 | Drlullaby Llc 400 W Ontario Street #512 Chicago IL 60654 Ph: (224) 572-8470 |
| NPI Number | 1598433898 |
|---|---|
| Provider Enumeration Date | 09/01/2021 |
| Last Update Date | 03/27/2023 |
| Certification Date | 03/27/2023 |
| Medicare PECOS PAC ID | 9931507290 |
|---|---|
| Medicare Enrollment ID | O20211018001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598433898 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lisa Medalie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609175744 PECOS PAC ID: 7315122520 Enrollment ID: I20110504000262 |
| Provider Name | Cheryl L Mcmullin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912441932 PECOS PAC ID: 9234412842 Enrollment ID: I20170206001429 |
| Provider Name | Nimra E Alvi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1336670868 PECOS PAC ID: 6002186137 Enrollment ID: I20200520000102 |
| Provider Name | Sarah Zwetzig |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851032064 PECOS PAC ID: 8820477979 Enrollment ID: I20220620001347 |
| Provider Name | Annie Lam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326352444 PECOS PAC ID: 6608047576 Enrollment ID: I20220622001864 |
| Provider Name | Christine Mason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063729390 PECOS PAC ID: 4880023142 Enrollment ID: I20220708003506 |
| Provider Name | Sheryl Leytham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891887162 PECOS PAC ID: 1658343280 Enrollment ID: I20220923001220 |
| Provider Name | Velesha Lera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053742650 PECOS PAC ID: 3678817970 Enrollment ID: I20230928000621 |
| Provider Name | Brittney Jones |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760010318 PECOS PAC ID: 0143682948 Enrollment ID: I20231121003025 |
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