Provider Demographics
NPI:1679786495
Name:ASSOCIATES IN BEHAVIORAL HEALTH S C
Entity Type:Organization
Organization Name:ASSOCIATES IN BEHAVIORAL HEALTH S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-817-1280
Mailing Address - Street 1:410 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3936
Mailing Address - Country:US
Mailing Address - Phone:847-817-1280
Mailing Address - Fax:847-336-1601
Practice Address - Street 1:410 HICKORY ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3936
Practice Address - Country:US
Practice Address - Phone:847-817-1280
Practice Address - Fax:847-336-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL368250Medicare ID - Type Unspecified