Provider Demographics
NPI:1700048568
Name:MAHER PSYCHIATRIC GROUP, LTD.
Entity Type:Organization
Organization Name:MAHER PSYCHIATRIC GROUP, LTD.
Other - Org Name:MAHER PSYCHIATRIC GROUP,LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:217-793-9593
Mailing Address - Street 1:3000 PROFESSIONAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703
Mailing Address - Country:US
Mailing Address - Phone:217-793-9593
Mailing Address - Fax:217-793-6949
Practice Address - Street 1:3000 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5931
Practice Address - Country:US
Practice Address - Phone:217-793-9593
Practice Address - Fax:217-793-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL369851Medicare UPIN