Provider Demographics
NPI:1841740214
Name:PERROTTA AND KRAUS PHDS PC
Entity Type:Organization
Organization Name:PERROTTA AND KRAUS PHDS PC
Other - Org Name:CENTERS FOR FAMILY CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-586-0900
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 101N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:630-586-9990
Practice Address - Street 1:2625 BUTTERFIELD RD
Practice Address - Street 2:SUITE 101N
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1234
Practice Address - Country:US
Practice Address - Phone:630-586-9991
Practice Address - Fax:630-586-9990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1295928968
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0126421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty