Provider Demographics
NPI:1639258056
Name:PSYCHODYNAMICS, P.C.
Entity Type:Organization
Organization Name:PSYCHODYNAMICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-604-4626
Mailing Address - Street 1:3118 N SHEFFIELD AVE
Mailing Address - Street 2:UNIT 1-S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8680
Mailing Address - Country:US
Mailing Address - Phone:847-604-4626
Mailing Address - Fax:
Practice Address - Street 1:3118 N SHEFFIELD AVE
Practice Address - Street 2:UNIT 1-S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8680
Practice Address - Country:US
Practice Address - Phone:847-604-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001626993OtherBCBSIL PROVIDER ID