| Family Child & Adolescent Psychiatric Services Sc | |
|
1 Old Frankfort Way Frankfort IL 60423-1719 | |
| (708) 206-1300 | |
| (708) 206-1399 |
| Full Name | Family Child & Adolescent Psychiatric Services Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1 Old Frankfort Way, Frankfort, Illinois |
| Authorized Official Name and Position | Mila B Aquino (MEDICAL BILLING SERVICE) |
| Authorized Official Contact | 9512820060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Child & Adolescent Psychiatric Services Sc 833 W 15th Pl Unit 815 Chicago IL 60608-1429 Ph: (708) 206-1300 | Family Child & Adolescent Psychiatric Services Sc 1 Old Frankfort Way Frankfort IL 60423-1719 Ph: (708) 206-1300 |
| NPI Number | 1598840936 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 05/11/2021 |
| Certification Date | 05/11/2021 |
| Medicare PECOS PAC ID | 1557310406 |
|---|---|
| Medicare Enrollment ID | O20050118000554 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598840936 | NPI | - | NPPES |
| 119475 | Other | IL | COMPSYCH PROVIDER # |
| 036067468 | Other | IL | LICENSE # |
| 155000 | Other | IL | PSYCHEALTH PROVIDER # |
| 166548 | Other | IL | HARMONY PROVIDER # |
| 018896 | Other | IL | VALUEOPTIONS PROVIDER # |
| 036067468 | Medicaid | IL | |
| 3103879 | Other | IL | BCBS |
| 31603879 | Other | IL | BCBS PROVIDER # |
| 35928 | Other | IL | AMERICAID PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036067468 (Illinois) | Primary |
| Provider Name | Clara T Perez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316906464 PECOS PAC ID: 6901855865 Enrollment ID: I20050119000028 |
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