Provider Demographics
NPI:1720370026
Name:ST MARYS PSYCHOLOGICAL SERVICE, INC
Entity Type:Organization
Organization Name:ST MARYS PSYCHOLOGICAL SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BISHAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-894-5169
Mailing Address - Street 1:20654 N PLUMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8500
Mailing Address - Country:US
Mailing Address - Phone:847-894-5169
Mailing Address - Fax:312-255-0362
Practice Address - Street 1:100 N RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1209
Practice Address - Country:US
Practice Address - Phone:847-894-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-007684103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty