Provider Demographics
NPI:1801852488
Name:VERTINO, ANTHONY DOMINIC (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DOMINIC
Last Name:VERTINO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2543
Mailing Address - Country:US
Mailing Address - Phone:773-330-5748
Mailing Address - Fax:
Practice Address - Street 1:3330 DUNDEE RD STE N4A
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2394
Practice Address - Country:US
Practice Address - Phone:224-235-4497
Practice Address - Fax:224-235-4497
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005990103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215322Medicare PIN