Provider Demographics
NPI:1083607303
Name:PRIBYL, MARY KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KAY
Last Name:PRIBYL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2222 CHESTNUT AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1674
Mailing Address - Country:US
Mailing Address - Phone:847-729-6290
Mailing Address - Fax:847-724-5629
Practice Address - Street 1:2222 CHESTNUT AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1674
Practice Address - Country:US
Practice Address - Phone:847-729-6290
Practice Address - Fax:847-724-5629
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-001140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
928250Medicare ID - Type Unspecified
SO7226Medicare UPIN