Provider Demographics
NPI:1699812073
Name:PYSKOTY, CHARLENE E (MA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:E
Last Name:PYSKOTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W ROSCOE ST
Mailing Address - Street 2:312
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1049
Mailing Address - Country:US
Mailing Address - Phone:773-348-4196
Mailing Address - Fax:
Practice Address - Street 1:6321 N AVONDALE AVE
Practice Address - Street 2:A101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1900
Practice Address - Country:US
Practice Address - Phone:773-774-7555
Practice Address - Fax:773-774-9396
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional