Provider Demographics
NPI:1154646503
Name:THE DEPRESSION CLINIC OF CHICAGO, LLC
Entity Type:Organization
Organization Name:THE DEPRESSION CLINIC OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DHEERAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-420-4552
Mailing Address - Street 1:10024 SKOKIE BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-9944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10024 SKOKIE BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-9944
Practice Address - Country:US
Practice Address - Phone:800-322-0949
Practice Address - Fax:800-322-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health