| Parkside Psychological Services, Llc | |
|
840 S Waukegan Rd Ste 203 Lake Forest IL 60045-2619 | |
| (847) 420-5088 | |
| Not Available |
| Full Name | Parkside Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 840 S Waukegan Rd Ste 203, Lake Forest, Illinois |
| Authorized Official Name and Position | Paul Smiley (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8474205088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkside Psychological Services, Llc 840 S Waukegan Rd Ste 203 Lake Forest IL 60045-2619 Ph: (847) 420-5088 | Parkside Psychological Services, Llc 840 S Waukegan Rd Ste 203 Lake Forest IL 60045-2619 Ph: (847) 420-5088 |
| NPI Number | 1295100485 |
|---|---|
| Provider Enumeration Date | 12/14/2015 |
| Last Update Date | 06/07/2021 |
| Certification Date | 06/07/2021 |
| Medicare PECOS PAC ID | 7416358155 |
|---|---|
| Medicare Enrollment ID | O20210701001210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295100485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071.007555 (Illinois) | Primary |
| Provider Name | Sharon Song |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912983651 PECOS PAC ID: 8224923164 Enrollment ID: I20040218001059 |
| Provider Name | Paul Smiley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588861579 PECOS PAC ID: 2264697846 Enrollment ID: I20210910002515 |
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