| Riverside Psychology | |
|
7627 Lake St Ste 222 River Forest IL 60305-1806 | |
| (708) 762-9602 | |
| Not Available |
| Full Name | Riverside Psychology |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 7627 Lake St Ste 222, River Forest, Illinois |
| Authorized Official Name and Position | Megan Baldassarre (OWNER) |
| Authorized Official Contact | 7087629602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Psychology 7627 Lake St Ste 222 River Forest IL 60305-1806 Ph: (708) 762-9602 | Riverside Psychology 7627 Lake St Ste 222 River Forest IL 60305-1806 Ph: (708) 762-9602 |
| NPI Number | 1083342299 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 10/21/2022 |
| Certification Date | 10/21/2022 |
| Medicare PECOS PAC ID | 4587032719 |
|---|---|
| Medicare Enrollment ID | O20221119000549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083342299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Megan E Baldassarre |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710332754 PECOS PAC ID: 4981995651 Enrollment ID: I20160628001029 |
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