| Park Ridge Psychotherapy And Counseling Services, Inc. | |
|
350 S Northwest Hwy Ste 300 Park Ridge IL 60068-4262 | |
| (312) 788-7874 | |
| Not Available |
| Full Name | Park Ridge Psychotherapy And Counseling Services, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 350 S Northwest Hwy Ste 300, Park Ridge, Illinois |
| Authorized Official Name and Position | Angela Marie Costanza (PRESIDENT/LCPC/PSYCHOTHERAPIST) |
| Authorized Official Contact | 3127887874 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Ridge Psychotherapy And Counseling Services, Inc. 350 S Northwest Hwy Ste 300 Park Ridge IL 60068-4262 Ph: () - | Park Ridge Psychotherapy And Counseling Services, Inc. 350 S Northwest Hwy Ste 300 Park Ridge IL 60068-4262 Ph: (312) 788-7874 |
| NPI Number | 1710405006 |
|---|---|
| Provider Enumeration Date | 09/06/2017 |
| Last Update Date | 09/25/2017 |
| Medicare PECOS PAC ID | 3476995580 |
|---|---|
| Medicare Enrollment ID | O20240521002323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710405006 | NPI | - | NPPES |
| 1568710432 | Other | IL | INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180010333 (Illinois) | Primary |
| Provider Name | Angela Marie Costanza |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568710432 PECOS PAC ID: 9638511744 Enrollment ID: I20240521002889 |
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