Provider Demographics
NPI:1689707440
Name:CORNERSTONE CLINICAL ASSOCIATES, LTD
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:630-871-0770
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-0921
Mailing Address - Country:US
Mailing Address - Phone:630-871-0770
Mailing Address - Fax:630-871-0772
Practice Address - Street 1:300 S COUNTY FARM RD
Practice Address - Street 2:SUITE E
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2438
Practice Address - Country:US
Practice Address - Phone:630-871-0770
Practice Address - Fax:630-871-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002341251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2220793OtherBCBS