Provider Demographics
NPI:1073684643
Name:USNDEK, DAVID CHARLES (PSYD LC PC CADC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:USNDEK
Suffix:
Gender:M
Credentials:PSYD LC PC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 N MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3903
Mailing Address - Country:US
Mailing Address - Phone:773-450-8049
Mailing Address - Fax:
Practice Address - Street 1:6031 N MARMORA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3903
Practice Address - Country:US
Practice Address - Phone:773-450-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4703103TC0700X
IL071007224103TC0700X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1053773226OtherNPI FOR INSIGHT PSYCHOLOGICAL SERVICES