Provider Demographics
NPI:1619094562
Name:GREGORY SARLO PSYCHOLOGICAL CONSULTATIONS, INC
Entity Type:Organization
Organization Name:GREGORY SARLO PSYCHOLOGICAL CONSULTATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SARLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-880-2235
Mailing Address - Street 1:2835 N SHEFFIELD AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5081
Mailing Address - Country:US
Mailing Address - Phone:773-880-2235
Mailing Address - Fax:773-880-2242
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:773-880-2235
Practice Address - Fax:773-880-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006228103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL777030Medicare ID - Type Unspecified