| Joliet Behavioral Health | |
|
300 N Republic Ave Joliet IL 60435 | |
| (815) 725-1440 | |
| (815) 725-1550 |
| Full Name | Joliet Behavioral Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 300 N Republic Ave, Joliet, Illinois |
| Authorized Official Name and Position | Mohammed N Ahmed (PROPRIETOR) |
| Authorized Official Contact | 8157251440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joliet Behavioral Health 14 Baybrook Ln Oak Brook IL 60523-1607 Ph: (815) 725-1440 | Joliet Behavioral Health 300 N Republic Ave Joliet IL 60435 Ph: (815) 725-1440 |
| NPI Number | 1245398502 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 06/07/2022 |
| Certification Date | 06/07/2022 |
| Medicare PECOS PAC ID | 4880609445 |
|---|---|
| Medicare Enrollment ID | O20060217000611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245398502 | NPI | - | NPPES |
| 02232165 | Other | IL | BCBS ID |
| 489953 | Other | IL | VALUEOPTIONS ID |
| 830310000 | Other | IL | MAGELLAN ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Illinois) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 036106568 (Illinois) | Primary |
| Provider Name | Mohammed Nayeemuddin Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275551871 PECOS PAC ID: 6406804624 Enrollment ID: I20050105000013 |
| Provider Name | Danellyn J Shannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477852796 PECOS PAC ID: 8022276401 Enrollment ID: I20120215000526 |
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