| Psychological Resource Center Pc | |
|
175 Olde Half Day Rd Suite 140-2 Lincolnshire IL 60069-3061 | |
| (708) 461-2333 | |
| (773) 751-2250 |
| Full Name | Psychological Resource Center Pc |
|---|---|
| Speciality | Psychologist |
| Location | 175 Olde Half Day Rd, Lincolnshire, Illinois |
| Authorized Official Name and Position | Mark Ira Bornstein (OWNER PRESIDENT) |
| Authorized Official Contact | 7084612333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Resource Center Pc 46 Cumberland Dr Lincolnshire IL 60069 Ph: (708) 461-2333 | Psychological Resource Center Pc 175 Olde Half Day Rd Suite 140-2 Lincolnshire IL 60069-3061 Ph: (708) 461-2333 |
| NPI Number | 1396856134 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 10/06/2009 |
| Medicare PECOS PAC ID | 8729061247 |
|---|---|
| Medicare Enrollment ID | O20041030000055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396856134 | NPI | - | NPPES |
| 4932021 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071004534 (Illinois) | Primary |
| Provider Name | Mark Ira Bornstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518078351 PECOS PAC ID: 3173426582 Enrollment ID: I20040131000103 |
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