Provider Demographics
NPI:1689296162
Name:KMETKO & ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:KMETKO & ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERSTATE SERVICES SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-561-6196
Mailing Address - Street 1:4043 N RAVENSWOOD AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1176
Mailing Address - Country:US
Mailing Address - Phone:773-561-6196
Mailing Address - Fax:773-687-9812
Practice Address - Street 1:4043 N RAVENSWOOD AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1176
Practice Address - Country:US
Practice Address - Phone:773-561-6196
Practice Address - Fax:773-687-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health