Provider Demographics
NPI:1821030024
Name:ROBERT M PASEN PHD PC
Entity Type:Organization
Organization Name:ROBERT M PASEN PHD PC
Other - Org Name:NEUROBEHAVIORAL HEALTH CONNECTIONS, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PASEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-566-0164
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0909
Mailing Address - Country:US
Mailing Address - Phone:847-566-0164
Mailing Address - Fax:847-566-0375
Practice Address - Street 1:201 E PARK ST
Practice Address - Street 2:UNIT B
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1973
Practice Address - Country:US
Practice Address - Phone:847-566-0164
Practice Address - Fax:847-566-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202530Medicare PIN