| Supportive Care Of Illinois Pc | |
|
410 N 2nd St Marshall IL 62441-1010 | |
| (866) 708-1240 | |
| Not Available |
| Full Name | Supportive Care Of Illinois Pc |
|---|---|
| Speciality | Psychologist |
| Location | 410 N 2nd St, Marshall, Illinois |
| Authorized Official Name and Position | Dov Newmark (CEO) |
| Authorized Official Contact | 7182982753 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Care Of Illinois Pc 27 Randolph Rd Howell NJ 07731-8611 Ph: () - | Supportive Care Of Illinois Pc 410 N 2nd St Marshall IL 62441-1010 Ph: (866) 708-1240 |
| NPI Number | 1861199911 |
|---|---|
| Provider Enumeration Date | 02/09/2023 |
| Last Update Date | 02/09/2023 |
| Certification Date | 02/08/2023 |
| Medicare PECOS PAC ID | 7113392804 |
|---|---|
| Medicare Enrollment ID | O20230411002061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861199911 | NPI | - | NPPES |
| Provider Name | Susan D Livingstone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215060751 PECOS PAC ID: 2567592702 Enrollment ID: I20100614000794 |
| Provider Name | Claudette Shunice Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528561032 PECOS PAC ID: 2567724578 Enrollment ID: I20180402001195 |
| Provider Name | Comfort O Lacy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497221162 PECOS PAC ID: 6507107364 Enrollment ID: I20190404002810 |
| Provider Name | Robert C Glenn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902033210 PECOS PAC ID: 9335328467 Enrollment ID: I20200622001680 |
| Provider Name | Colleen M Kucera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528702644 PECOS PAC ID: 4183002157 Enrollment ID: I20220602002198 |
| Provider Name | Cawonda Ranee Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417648148 PECOS PAC ID: 3274994512 Enrollment ID: I20230802001846 |
| Provider Name | Shola Alice Owoyemi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699460121 PECOS PAC ID: 4880042639 Enrollment ID: I20231205000413 |
| Provider Name | Abidemi Oluwakemi Balogun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205605235 PECOS PAC ID: 3173975778 Enrollment ID: I20240119000372 |
| Provider Name | Natasch M Lindsey-acker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922676493 PECOS PAC ID: 9830542505 Enrollment ID: I20240129004391 |
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