Provider Demographics
NPI:1528208873
Name:GERIATRIC PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:GERIATRIC PSYCHIATRIC SERVICES PLLC
Other - Org Name:GPS INDIANA LMSW GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-620-8100
Mailing Address - Street 1:28800 RYAN RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4272
Mailing Address - Country:US
Mailing Address - Phone:568-620-8100
Mailing Address - Fax:866-227-7418
Practice Address - Street 1:1721 MOON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:847-519-3650
Practice Address - Fax:847-519-3642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERIATRIC PSYCHIATRIC SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty