| S S Behavioral Health Inc | |
|
477 E Butterfield Rd Ste 102 Lombard IL 60148-4880 | |
| (630) 528-3835 | |
| (630) 528-3837 |
| Full Name | S S Behavioral Health Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 477 E Butterfield Rd Ste 102, Lombard, Illinois |
| Authorized Official Name and Position | Mohammed S Siddiqui (PRESIDENT) |
| Authorized Official Contact | 6302902246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| S S Behavioral Health Inc 1415 S Ardmore Ave Unit 7020 Villa Park IL 60181-5871 Ph: (630) 317-4360 | S S Behavioral Health Inc 477 E Butterfield Rd Ste 102 Lombard IL 60148-4880 Ph: (630) 528-3835 |
| NPI Number | 1801313721 |
|---|---|
| Provider Enumeration Date | 08/23/2017 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Medicare PECOS PAC ID | 6002180411 |
|---|---|
| Medicare Enrollment ID | O20170925001056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801313721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036-131386 (Illinois) | Secondary |
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | 036-131386 (Illinois) | Primary |
| Provider Name | Tekekee D Buckner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538442918 PECOS PAC ID: 6709052582 Enrollment ID: I20111228000398 |
| Provider Name | Mohammed Siddiqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639456122 PECOS PAC ID: 8729224720 Enrollment ID: I20130417000630 |
| Provider Name | Marie Steta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588055958 PECOS PAC ID: 6507186632 Enrollment ID: I20150513001515 |
| Provider Name | Denise Gallagher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891072443 PECOS PAC ID: 2365781960 Enrollment ID: I20190226001445 |
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