Provider Demographics
NPI:1407040942
Name:BIOPSYCHTECH OF CHICAGO, LTD
Entity Type:Organization
Organization Name:BIOPSYCHTECH OF CHICAGO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-907-3644
Mailing Address - Street 1:8633 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9584
Mailing Address - Country:US
Mailing Address - Phone:312-907-3644
Mailing Address - Fax:219-879-2525
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:STE 1801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-907-3644
Practice Address - Fax:219-879-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041831A103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL986481Medicare PIN