Provider Demographics
NPI:1275738130
Name:SHARED VISION PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SHARED VISION PSYCHOLOGICAL SERVICES
Other - Org Name:SHARED VISION PSYCHOLOGICAL SERVICES, DBA PEDIATRIC PSYCHOLOGY ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-571-1110
Mailing Address - Street 1:1200 HARGER RD
Mailing Address - Street 2:#600
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-571-5750
Mailing Address - Fax:630-571-5751
Practice Address - Street 1:1200 HARGER RD
Practice Address - Street 2:#600
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:630-571-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty