Provider Demographics
NPI:1437867033
Name:PEIST, ERIC ALEXANDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALEXANDER
Last Name:PEIST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 N LINCOLN AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3180
Mailing Address - Country:US
Mailing Address - Phone:914-318-3016
Mailing Address - Fax:
Practice Address - Street 1:1440 N DAYTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2644
Practice Address - Country:US
Practice Address - Phone:312-227-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical