Provider Demographics
NPI:1871644385
Name:PANEPINTO, AMBERLY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMBERLY
Middle Name:R
Last Name:PANEPINTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 N TALMAN AVE # 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-9409
Mailing Address - Country:US
Mailing Address - Phone:312-310-8560
Mailing Address - Fax:
Practice Address - Street 1:4653 N BROADWAY ST
Practice Address - Street 2:SUITE 530
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5011
Practice Address - Country:US
Practice Address - Phone:312-310-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636536OtherBCBS