Provider Demographics
NPI:1205376043
Name:HARVARD PSYCHOLOGY AND ASSOCIATES
Entity Type:Organization
Organization Name:HARVARD PSYCHOLOGY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-814-4193
Mailing Address - Street 1:107 E SUMNER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-2840
Mailing Address - Country:US
Mailing Address - Phone:815-814-4193
Mailing Address - Fax:815-943-6540
Practice Address - Street 1:107 E SUMNER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2840
Practice Address - Country:US
Practice Address - Phone:815-814-4193
Practice Address - Fax:815-943-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1134215130OtherINDIVIDUAL NPI
IL345468451001Medicaid
206506Medicare UPIN