Provider Demographics
NPI:1467086470
Name:CORE PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CORE PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-343-3432
Mailing Address - Street 1:155 N MICHIGAN AVE STE 721
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7707
Mailing Address - Country:US
Mailing Address - Phone:312-343-3432
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 721
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7707
Practice Address - Country:US
Practice Address - Phone:312-343-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1932231461OtherTYPE I NPI (MONIQUE (HERNANDEZ) CLEMINSON)