Provider Demographics
NPI:1225377294
Name:CENTER FOR BEHAVIORAL MEDICINE, LTD
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL MEDICINE, LTD
Other - Org Name:CHICAGOCBM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-569-0285
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:STE 1025
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-569-0285
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:STE 1025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-569-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty