Provider Demographics
NPI:1316568629
Name:KEREKES, DENISA
Entity Type:Individual
Prefix:
First Name:DENISA
Middle Name:
Last Name:KEREKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-6346
Mailing Address - Country:US
Mailing Address - Phone:847-322-2520
Mailing Address - Fax:
Practice Address - Street 1:1536 CEDARWOOD CT
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-6346
Practice Address - Country:US
Practice Address - Phone:847-322-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty