Provider Demographics
NPI:1518149509
Name:ROGER A. LUPEI PHD P C
Entity Type:Organization
Organization Name:ROGER A. LUPEI PHD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUPEI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-524-0307
Mailing Address - Street 1:1024 NORTH BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1169
Mailing Address - Country:US
Mailing Address - Phone:708-524-0307
Mailing Address - Fax:
Practice Address - Street 1:1024 NORTH BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1169
Practice Address - Country:US
Practice Address - Phone:708-524-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty