| Main St. Psychiatry, S.c. | |
|
10 W Main St Cary IL 60013-2866 | |
| (815) 526-3781 | |
| (815) 526-3094 |
| Full Name | Main St. Psychiatry, S.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10 W Main St, Cary, Illinois |
| Authorized Official Name and Position | Joanne Gail Parks (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8155263781 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main St. Psychiatry, S.c. 5911 Northwest Hwy Ste 207 Crystal Lake IL 60014-8043 Ph: (815) 526-3781 | Main St. Psychiatry, S.c. 10 W Main St Cary IL 60013-2866 Ph: (815) 526-3781 |
| NPI Number | 1346756491 |
|---|---|
| Provider Enumeration Date | 12/26/2017 |
| Last Update Date | 11/22/2024 |
| Certification Date | 11/22/2024 |
| Medicare PECOS PAC ID | 0648535013 |
|---|---|
| Medicare Enrollment ID | O20180606000720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346756491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 36-086270 (Illinois) | Primary |
| Provider Name | Joanne G Parks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619019148 PECOS PAC ID: 3375629447 Enrollment ID: I20080329000060 |
| Provider Name | Sherry T Aleksich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114173523 PECOS PAC ID: 3870652225 Enrollment ID: I20151223000181 |
| Provider Name | Donna L Derose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285168120 PECOS PAC ID: 7416234505 Enrollment ID: I20170427000134 |
| Provider Name | Lisa M Trautman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861987604 PECOS PAC ID: 8820408008 Enrollment ID: I20201028002491 |
| Provider Name | Abigail D Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386303329 PECOS PAC ID: 5496141509 Enrollment ID: I20220329001999 |
| Provider Name | Tiesha R Panek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477250595 PECOS PAC ID: 7911358478 Enrollment ID: I20240109001959 |
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