Provider Demographics
NPI:1710927520
Name:LAKEVIEW PSYCHIATRY & COUNSELING
Entity Type:Organization
Organization Name:LAKEVIEW PSYCHIATRY & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETRIT
Authorized Official - Middle Name:
Authorized Official - Last Name:NDRIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-331-5220
Mailing Address - Street 1:2650 N LAKEVIEW AVE
Mailing Address - Street 2:UNIT 1210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1840
Mailing Address - Country:US
Mailing Address - Phone:847-331-5220
Mailing Address - Fax:773-528-2832
Practice Address - Street 1:2650 N LAKEVIEW AVE
Practice Address - Street 2:UNIT 1210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1840
Practice Address - Country:US
Practice Address - Phone:847-331-5220
Practice Address - Fax:773-528-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
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