Provider Demographics
NPI:1578714499
Name:PSYCHOEDUCATIONAL RESOURCE SERVICES
Entity Type:Organization
Organization Name:PSYCHOEDUCATIONAL RESOURCE SERVICES
Other - Org Name:PRS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:RASTRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:847-508-7846
Mailing Address - Street 1:5225 OLD ORCHARD RD
Mailing Address - Street 2:26A
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4405
Mailing Address - Country:US
Mailing Address - Phone:847-508-7846
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:26A
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-508-7846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1683662103TS0200X
IL1691243103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty