Provider Demographics
NPI:1497888275
Name:VERVILLE, DENNIS R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:VERVILLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE ST STE 280-D
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1015
Mailing Address - Country:US
Mailing Address - Phone:708-205-8028
Mailing Address - Fax:855-847-4919
Practice Address - Street 1:1100 LAKE ST STE 280-D
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1015
Practice Address - Country:US
Practice Address - Phone:708-205-8028
Practice Address - Fax:855-847-4919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical